ORAL ANSWERS TO QUESTIONS

HEALTH

The Secretary of State was asked-

Dentistry (Shropshire)

Daniel Kawczynski: What plans there are to improve NHS dental provision in Shropshire.

Ann Keen: The Department has invested a record £2 billion in dentistry and set up a national access programme to help the national health service deliver its commitment to providing, by 2011, access for all who seek it. It is, of course, the responsibility of Shropshire County primary care trust to plan and develop appropriate services, including dental services, to meet the needs of its resident population.

Daniel Kawczynski: I thank the Minister for that answer, but I must tell her that my experience of trying to find an NHS dentist in Shrewsbury for myself and my family has been an absolute nightmare. Can she provide me with a list of NHS dentists in Shrewsbury and Atcham that are currently taking on patients, so that I can share that with my constituents?

Ann Keen: I am sorry that the hon. Gentleman and his family were troubled with uncomfortable dental pain at some time, but I know that he accessed the advice line and that he was assisted. I would be happy to talk outside the Chamber about any particular points that he wants to make on that. Of course, access to NHS dentistry has grown in Shropshire. Over the past 12 months the number of people who have seen an NHS dentist has risen by more than 11,000. I am aware that the PCT is tendering three new contracts-in Market Drayton, Oswestry and Bridgnorth-which are due to start in April 2010, and a new contract was tendered in 2006 for Shrewsbury as a high-priority area.

Trafficked Women

Anthony Steen: What recent representations the health taskforce on violence against women and girls has received on the role and response of health services in respect of trafficked people.

Ann Keen: The taskforce has heard evidence from many groups representing women and children who are victims of all forms of violence, including trafficking. The taskforce on the health aspects of violence against women and girls, chaired by Sir George Alberti, is currently considering the report and the recommendations of the sub-group on harmful traditional practices and trafficking, which it established for that purpose.

Anthony Steen: Is the Minister aware that many trafficked women display multiple problems, both physical and mental, and that when they go to accident and emergency units in hospitals, as well as to general practitioners, they are not readily identified as trafficked women, but viewed as victims of violence? Will she therefore consider whether we could improve training for both GPs and hospital staff, so that when they actually meet battered or mentally disturbed women who have been trafficked, they recognise that, rather than seeing them simply as victims of violence?

Ann Keen: First, I am sure the whole House congratulates the hon. Gentleman on his work with the all-party group. He has been such a force for good, and not only in our own country: he has often visited other European countries to see what is happening.
	I know that Devon black and minority ethnic community development workers engage with vulnerable communities, but the taskforce is such an important one and the questions are so relevant. The training that health care workers receive for meeting difficult situations will be covered in Sir George Alberti's report, which we expect to be published in early February. A specific training mandate will, I feel, be put in place from those recommendations.

Alan Simpson: I doubt whether anyone can match the hon. Member for Totnes (Mr. Steen) for the work he has done on this issue, but my limited experience of it prompts me to ask whether the interface that trafficked women have with health services in the voluntary sector can be assisted by overcoming the linguistic barriers, which are part of the problem. In many cases there is a heavy dependence on people who are themselves part of refugee communities to act as translators. Often, they have real difficulties facing the Home Office when addressing their own problems regarding deportation. Will the Minister ask for a coherent interface between key workers and those within the refugee communities in that process, to ease the problems that those women face?

Ann Keen: My hon. Friend raises some more excellent points. Those areas are covered by the research and the report's findings, and we are working across Government with other Ministers, particularly Home Office Ministers, to address that very point.

NHS Funding

Roberta Blackman-Woods: What account is taken of relative levels of deprivation in determining NHS resource allocations.

Andy Burnham: Deprivation is accounted for in the NHS funding formula, which reflects both deprived and older populations' greater need for health care. An additional health inequalities component in the formula directs funding to the places with the worst health outcomes, targeting health inequalities better than ever before.

Roberta Blackman-Woods: Can the Secretary of State tell the House whether he has any further plans to try to reduce health inequalities by targeting resources further towards the most deprived areas of the country? Does he agree that the Opposition's premium pledge is just a sham, because the policy is already being implemented by the Government?

Andy Burnham: I can say to my hon. Friend that next year County Durham PCT will receive £1,800 per head of population, £200 more than the England average, reflecting the fact that there are higher levels of disease and deprivation in her local community. Obviously that has been a component of the formula since 1999. The Advisory Committee on Resource Allocation in the NHS keeps the matter under review, and it says that the decision is an interim step to give more money to tackle health inequalities. We keep the matter under review, and I can advise my hon. Friend that Professor Marmot will shortly give us his report on further action to tackle health inequalities, which we shall consider in due course.

Philip Davies: Surely the purpose of the NHS is simply to treat individuals, wherever they happen to live around the country, with the treatment that they need to deal with their particular problems. Will the Secretary of State confirm that all health spending will be given on that basis, and that basis alone, rather than basing it on the socio-economic environment in which an individual lives?

Andy Burnham: I am told that there is a general election not too far off. May I respectfully point out to the hon. Gentleman that it might help him to read his party's draft manifesto from last week, which included the commitment to
	"weight public health funding so that extra resources go to the poorest areas"?
	He is going to be standing on that manifesto in a few months, so he had better read it-and pretty quickly, I would say.

Kevin Barron: Can my right hon. Friend tell us what the level of resources per head was 10 years ago?

Andy Burnham: I can say to the Chairman of the Select Committee on Health that the England average next year will be £1,600 per head of population. Turning the clock back 10 years, we see that it used to be £426 per head of population. That figure demonstrates the change that this country voted for when it elected a Labour Government. The country was saying, "Our NHS needs to be put back on its feet. We need to invest in it to give people in all parts of the country the best possible health care." In that figure alone we can see the difference that this Labour Government have made.

Norman Lamb: The Secretary of State will be aware that GP practices in deprived communities lose out financially and that there are 18 per cent. fewer GPs working in poorer communities. He will also be aware that the Health Committee heard evidence of the failure of the incentive scheme for payments to GPs to do anything effective about health inequalities. There is evidence supporting the call for radical action to change the way in which the qualities and outcomes framework works. When will the Government take action to change the current completely unacceptable situation, whereby GPs in richer areas are paid better than those in poorer communities?

Andy Burnham: Of course we keep such matters under review at all times. However, the funding formula for general practice contains a minimum practice income guarantee, which protects precisely those practices to which the hon. Gentleman referred. I would also point him towards the respected international Commonwealth Fund, which late last year published a comparison of primary care in the 12 most developed countries around the world. It is a source of huge pride to me and to every Member on the Government Front Bench-indeed, to every Member on the Labour Benches-that primary care under this Labour Government is the envy of the world.

Parmjit Dhanda: Is my right hon. Friend aware that the alternative formula that was put forward in this Chamber three years ago by the hon. Member for South Cambridgeshire (Mr. Lansley) would reduce the funding going to our local NHS in Gloucestershire by £109 for every man, woman and child who lives there? Will my right hon. Friend resist that 9 per cent. cut to our local NHS?

Andy Burnham: What I would say to my hon. Friend is that we have sat in the House over the past five years of this Parliament and heard every member of the shadow health team criticise the Government for allocating more resources to communities with higher health needs and more deprivation. So when we read what the Opposition's policy in their draft manifesto is, I do not know how they have the brass neck to sit there today and look as though it was always their policy: it beggars belief. The Opposition need to spell out which PCTs will win and which will lose under the new policy. I suspect that my hon. Friend's PCT might lose from a policy that gave more money to deprivation, on top of what we give such communities today.

Andrew Lansley: May I just say how much we will miss David Taylor at our Health questions and health debates? He was always here, and always had good insights and real commitment to the national health service. He will be much missed, as he was a good colleague to us all.
	Will the Secretary of State confirm that patients should be able to expect equivalent access to treatment from the NHS wherever they are in the country? Will he explain why in his Leigh constituency, the NHS spends over 40 per cent. more on cancer services per cancer patient than it does in my constituency?

Andy Burnham: I would like to begin by echoing the shadow Health Secretary's remarks about David Taylor, who was a regular attender at Health questions and health debates; I am sure that his voice will be sorely and genuinely missed by Members on all sides of the House.
	The answer to the hon. Gentleman's question is that my constituency has more deprivation and ill health than his does, and that is picked up in the funding formula. I am amazed that the hon. Gentleman is asking this question when his manifesto of last week said in terms that his party will adopt precisely the same policy-so how can he stand at the Dispatch Box and criticise the fact that my constituency of Leigh, a former mining area, receives more for its greater health needs?

Andrew Lansley: The Secretary of State just doesn't get it. I was quoting the figures on the amount spent by the NHS in each of those areas per cancer patient-not the overall allocation between the areas, but the amounts spent per cancer patient. Let me give him another example. Perhaps he can explain why, although higher NHS allocations go to more deprived areas, the money is spent on responding to the consequences of ill health rather than on preventing disease, which is the reason why it is allocated. Why is there one hospital bed for every 245 people in the north-east of England, but one bed for every 408 people in South Central?

Andy Burnham: I am genuinely confused, because for five years, from his side of the Dispatch Box, the hon. Gentleman has accused us of spending too much money in constituencies such as mine. The reason why my area can spend more on cancer is that, historically, smoking has been higher in the constituency. It was the hon. Gentleman's manifesto of last week that said that the Conservatives would weight public health funding so that more went to deprived areas. So he would give my constituency more money than it gets today-yet every one of the Conservative Front-Bench team has criticised our funding plans. The hon. Gentleman should either accept the situation today and tell us which primary care trusts will get more and which will get less, or realise that his policy will have no credibility whatever.

Andrew Lansley: He still doesn't get it, does he? Will he explain why the local PCT in his constituency presently spends £39 a head on its management costs but just £31 a head on its healthy individuals programme, which is preventive spend. That is the point; this is about prevention. What is needed is higher public health budgets for the areas with the poorest health: less bureaucracy, more prevention-that is our health premium. Will he not just accept that we need real help to reduce health inequalities through preventive health care-because we can't go on like this?

Andy Burnham: It is our policy to allow local PCTs to decide where they spend the money on the areas that they think will have the most impact, whether that be prevention or cancer. For the last five years the hon. Gentleman has accused me of giving too much money to those areas, and now he has completely abandoned that pledge. It would appear that it is not him but his party leader who is now writing his shadow health policy. Let me tell the hon. Gentleman, who sits there and gives out the orders, that he has had his policy on single rooms dropped, and he has had his policy on health resources dropped, so why does he not book himself-

Mr. Speaker: Order. I am extremely grateful to the Secretary of State, and I know that he wants to say something about other parties' policies, but he must now focus exclusively upon his own.

Dari Taylor: My right hon. Friend will know that my constituency has had significantly increased funds. None the less, we have very high death rates from heart problems and cancer in low-income wards. How can we manage that situation? What education and community programmes are there to help people in low-income families understand the serious dangers from smoking and poor nutrition?

Andy Burnham: My hon. Friend is right. We need to give the resources to areas such as hers so that they can spend them on smoking cessation programmes and improving access to primary care. Research has shown that communities of that kind benefit greatly from improved primary care, and also that national targets have played an important role in improving health outcomes in the most deprived communities. I assure my hon. Friend that that will remain a central tenet of this Government's health policy.

Mental Health

Julian Lewis: I note that the Minister of State is to answer this question, which will give the Secretary of State a chance to calm down.

Phil Hope: Acute care services, including psychiatric intensive care units, remain an essential component of the Government's drive to improve and modernise our mental health services. Moreover, as a result of nine consecutive years of increased mental health spending, more people with acute mental health problems are being treated in the community than ever before.

Julian Lewis: I give the Government full credit for the creation of the psychiatric intensive care unit at Woodhaven hospital in my constituency. That is why I am so concerned about the fact that it has been "temporarily" closed for the last three months. Six patients from the New Forest who are in desperate need of its assistance have been farmed out to Havant and Basingstoke. May I appeal once more to the Minister to intervene to ensure that Ellingham ward at Woodhaven is reopened as soon as possible?

Phil Hope: The hon. Gentleman has raised this matter with me before, both at Question Time and during debates in Westminster Hall. Since our debate last October, Hampshire Partnership NHS Foundation Trust and Hampshire primary care trust have established an independent review panel to examine their proposals to change services provided by the psychiatric intensive care unit. An updated report will be sent to the Hampshire health overview and scrutiny committee on 26 January, and the full report will be completed within a month. The independent review will be conducted by a panel of experts, including an independent consultant psychiatrist and an independent director of nursing.
	I hope that that reassures the hon. Gentleman that his concerns are being heard, that action is being taken and that an independent review will ensure that we secure the best possible outcome for patients, based on a clinical assessment of their needs.

Cancer Treatment

Tony Lloyd: What plans he has to increase the speed of treatment of people presenting to their GPs with symptoms consistent with cancer.

Andy Burnham: Over 94 per cent. of patients currently see a cancer specialist within two weeks of urgent referral for suspected cancer by their GP. Of those subsequently diagnosed, 85.7 per cent. commenced treatment within 62 days. We have plans to offer patients in England access to diagnostics that may confirm or exclude cancer within one week.

Tony Lloyd: Can my right hon. Friend confirm that if the Government's cancer pledge that patients will be referred within a week comes to fruition, it will save 10,000 lives every year? That is very significant, given that cancer is still seen not simply as a major killer but as a major condition, in terms of people's view of health care in this country. Is there any chance of my right hon. Friend being able to persuade Opposition parties that consensus would be in the national interest?

Andy Burnham: I can confirm that the aim of reducing to one week the wait that people experience during what is probably the most stressful time of their lives is very much the Government's policy. The national cancer director has estimated that that would indeed save 10,000 lives every year. As my hon. Friend says, the key challenge is early diagnosis. We must focus, and are focusing, all our efforts on that. I do not believe that some of the policies promoted by others would get us anywhere. In fact, they would return us to the days of a postcode lottery for those important services.

Mark Simmonds: I am well aware that that exchange constituted an attempt to shed light on Conservative policy. Of course the Conservative party wants to see improvements in the provision of cancer services. As the Secretary of State said, there must be a much greater focus on prevention, earlier presentation leading to earlier diagnosis, faster access to innovative drugs and treatments, swifter implementation of survivorship initiatives, and implementation of quality indicators. All those will improve under a future Conservative Government. The key question that the Secretary of State needs to answer is why, despite the Government's 12 years in office, Britain's five-year cancer survival rates are still among the worst in Europe.

Andy Burnham: Without going into all the nonsense and waffle with which the hon. Gentleman began his question, may I just give him his answer? In a letter to me last year, which prefaced the "Cancer Reform Strategy" annual report, the national cancer director said that there had been a further fall in cancer mortality in the last two years for which figures were collected. Overall, therefore, there has been a decrease of 19.3 per cent. among under-75s since 1995-97. In his words:
	"We are well on track to achieve the target of a 20 per cent. reduction by 2010."
	The hon. Gentleman did not say that he would remove targets, but he needs to explain how we would achieve such improvements if we were to simply drop all the targets.

GP Surgeries

Andrew Gwynne: What proportion of GP surgeries are open in the evenings and at weekends.

Mike O'Brien: Some 77 per cent.-three quarters-of GP surgeries in England are open outside normal surgery hours, offering their patients routine appointments. We expect this figure to continue to rise.

Andrew Gwynne: I thank my right hon. and learned Friend for that answer. As somebody who, unfortunately, had to make extensive use of GP services over the Christmas recess, including the out-of-hours service at the new Tameside walk-in centre, may I say how massively convenient it is now that my local GP services are operating extended hours? However, what more is being done for patients of GPs who are not yet offering that provision?

Mike O'Brien: My hon. Friend is right to say that we need to do more to ensure that extended hours are offered. We intend to give patients a right to register with a practice of their choice-perhaps one that offers extended hours. Furthermore, neighbouring doctors can apply to be paid for seeing patients of practices that do not offer extended hours. The Government's extended hours policy has been an increasing success-but of course if the Tories are elected, they will get rid of it.

David Evennett: This is an issue of great concern to my constituents. I note the Minister's response to the previous question, but is he confident that the full range of GP services, such as pharmacies and access to a nurse, are available during weekend and extended hours in south-east London?

Mike O'Brien: We are increasingly moving towards getting a larger range of services, particularly for GPs. Levels of nursing and pharmacy services vary between practices, but we want to ensure that we increase the number. However, when the hon. Gentleman stands on his party's manifesto, he will have to recognise that his party would get rid of those requirements: that appears to be its announced policy.

Charlotte Atkins: What contribution are the new GP-led health centres making to greater access to GPs? In my own area, a new health centre is being built in Biddulph. It will be the first time that my constituents have had access to out-of-hours GP services in the evenings and at weekends.

Mike O'Brien: The new GP-led health centres are providing a real incentive for practices that up to now have not offered extended hours. They can see that GP-led health centres are there, and that some patients will start to use them unless GPs start to offer the extended hours. GPs can also see that, with £161 million available in the coffers of PCTs, additional funding is available for GP practices that offer extended hours.

NHS (Charitable Funding)

David Heathcoat-Amory: What his estimate is of the amount of charitable giving to NHS institutions in the latest period for which information is available.

Phil Hope: In 2008-09, NHS trusts and primary care trusts in England received contributions from all charitable sources totalling £62 million in expenditure and £65 million in fixed assets. The Department does not collect that information for NHS foundation trusts, which report directly to Monitor.

David Heathcoat-Amory: Is the Minister aware that the Burnham-on-Sea memorial hospital extension was funded by its magnificent league of friends, and that that form of local charitable giving would be betrayed if it were regarded as part of the general NHS budget and used by the Government to make offsetting reductions in the funding for the NHS trust concerned? Will the Government give an absolute assurance that such a change, which is being considered, will not happen?

Phil Hope: I can tell the right hon. Gentleman that that is not the case, and never will be.

Ken Purchase: And never has been.

Phil Hope: Indeed, as my hon. Friend says, it never has been the case.
	Charity trustees will continue to have full responsibility for charitable funds; they are not, and will not be, part of NHS budgets. There is a question about accounting requirements-I think that that is what the right hon. Gentleman was referring to-but that is not a matter of Department of Health jurisdiction. However, I continue to work with the Treasury, Monitor, the Charity Commission and other stakeholders to seek ways of strengthening the independent governance of NHS charities, to ensure that we meet that standard without invoking the requirement for consolidation, and that matter is currently under discussion.

Jane Kennedy: What are the latest figures for charitable giving to the Royal Liverpool Children's NHS Trust? If my hon. Friend does not have those figures to hand, may I, through him, pass on an invitation from the hospital to our right hon. Friend the Secretary of State? The hospital invites the Secretary of State to visit it so that, on his way to Goodison Park, he can see for himself the tremendous contribution that charitable giving makes to the new hospital that will be built with funds from the £1.2 billion committed by this Government to Merseyside for new hospitals.

Phil Hope: My right hon. Friend is absolutely right to say that charitable giving makes a huge difference. Many people who have experience of the national health service want as a result to make a gift or donation to thank it for the support and care it has given them, or a loved one. Many charities work closely with NHS institutions and NHS charities. This is a cause for celebration, and I want to make it clear today how much we value that, and that that independence is absolutely right. There is no question whatever that charitable funds could be used as part of NHS budgets; I want that very important message to go out from the House today.

Norman Lamb: But the Minister will be aware that this question is causing enormous concern. Why has the confusion been allowed to continue for so long, given that the Charity Commission alerted the Treasury and the Department of Health to the problem in August 2008? The Charity Commission has made it clear that such an arrangement is not necessary or appropriate for charities in the state sector. The accounting rules concerned apply in the private sector. Why can we not rule it out once and for all?

Phil Hope: As I hope I have already suggested, we are actively looking into the dilemma that the hon. Gentleman describes, and I hope that he and all other Members of this House, as well as charities and the NHS, will join me in ensuring that we do not spread confusion and mislead people about the consequences of looking at those accounting standards. Let us be absolutely clear: we very much welcome people making contributions through charities to support those receiving health services. The role of NHS charities is crucial. Only one in 10 NHS charities are even affected by this possible accountancy change. It makes no difference to the NHS; it is not part of the NHS. I would hope that the hon. Gentleman would join me in ensuring that we put the record straight, and do not mislead or misguide people and deter them in any way from making such contributions.

Lindsay Hoyle: My local hospital-the wonderful Chorley hospital-is part of the Lancashire Teaching Hospitals NHS Foundation Trust. Why can we not ask for information, but our question has to go to Monitor instead? Surely, as a Member of Parliament, I should have the same rights as other MPs in being able to ask questions for Ministers to answer. Does the Minister not agree?

Phil Hope: My view is that Members of Parliament can ask Monitor for information, and can receive that information. I think that is entirely appropriate, and I would encourage Members who have questions they want to ask of Monitor to put them with the usual vigour with which they put question to Ministers here at the Dispatch Box.

Stephen O'Brien: Despite the answers that the Minister has just given-this is of particular relevance to those of us who are trustees of charities and are finding that this problem is exercising us a lot in respect of our various fiduciary duties-the Government are still allowing there to be a risk of charitable donations being subsumed into hospital accounts. When people give to charity, they expect that money to be for extra things, rather than for those that are part of the established costs in the NHS budget. Will the Minister give an absolute guarantee that under the Treasury's new rules there will be no danger whatever of money given to charity being counted as part of the NHS budget, and that there will be no resultant offsetting?

Phil Hope: The short answer is yes. The long answer is that NHS charities are not part of the NHS, have never been part of the NHS and, under this Government, never will be part of the NHS. They are independent bodies, governed by an independent regulator, doing fantastic work in providing fantastic services. I hope that the hon. Gentleman-and the hon. Member for North Norfolk (Norman Lamb), who speaks for the Liberal Democrats-will stop putting out misleading information, and instead will reinforce the fact that NHS charities remain independent.

GP Telephone Numbers

Laurence Robertson: What recent guidance his Department has issued to GP practices on their use of 0844 telephone number systems; and if he will make a statement.

Mike O'Brien: The Department issued guidance and directions to the NHS in England on 21 December, just before Christmas, that patients should not be expected to pay more than the cost of a local call to contact the NHS, including doctors' surgeries. GPs will have this year to end the practice completely and get out of any contracts that cause that to happen.

Laurence Robertson: I thank the Minister for that response, but he will be aware that the practice is continuing. He says that it must end this year, but there is an awful lot of this year left, so when does he expect the practice to end? Not only does it make it expensive for people to call their local general practitioner, but older people in particular often prefer a human being to answer the phone, rather than be responded to by a machine.

Mike O'Brien: I agree that we need to ensure that this practice of some GPs charging more than a local rate for contact ends as quickly as possible. We have made it absolutely clear to GPs that they must get out of these contracts-a number of practices have signed up to and are legally bound by them-and they have the year to do so. We have engaged with some of the companies involved and, to be fair to them, they have said they are prepared to negotiate equitable arrangements with the GPs to see whether we can get them all out of this as soon as possible. They have all got to be out by 21 December, but we want them to be out now, or as soon as they possibly can be.

Michael Penning: This situation is not just in the hands of GPs; the provider that the patient is using is also ripping them off. For instance, when someone phones a GP's surgery on an 0845 number from a call box, the charges will be over the top, and people will still be charged even on the new 0300 numbers. Will the Minister examine why these patients are still being ripped off by their providers, as well as by GPs?

Mike O'Brien: Our objective is to ensure that anyone trying to contact the NHS locally pays a local rate, and we need to ensure that such practice is adopted. If the hon. Gentleman has evidence to suggest that particular issues are arising, I would be happy to discuss them with him.

Alternative Medicine

David Tredinnick: When he expects to publish his proposals for the regulation of practitioners of acupuncture, herbal medicine and traditional Chinese medicine, following his Department's consultation on the matter; and if he will make a statement.

Gillian Merron: More than 6,000 responses to the consultation, which closed on 16 November, have been received and are being analysed. Our response will be published as soon as possible.

David Tredinnick: This has been going on since 2004, so surely the Department can give us a date. Is the Minister aware that the Northern college of traditional Chinese medicine, which is in its 21st year, has had its university accreditation withdrawn by the university of Central Lancashire because there is no statutory regulation of this sphere? That is the fault of Ministers and something needs to be done-they need to get on with it.

Gillian Merron: I understand the hon. Gentleman's frustration with the amount of time that has been taken, but I know that he also understands that any regulation would need to be balanced and proportionate. These are complex issues and we want to get this right. I assure the House that Ministers are keen to see publication as soon as possible.

Purley Hospital

Richard Ottaway: When he expects redevelopment of Purley hospital to take place.

Mike O'Brien: Croydon primary care trust and the Mayday Healthcare NHS Trust are firmly committed to the redevelopment of Purley hospital. It is for those organisations to determine a timetable, and both have assured me that they will seek to keep the hon. Gentleman informed of the progress. I understand that he had recent meetings with at least one of them.

Richard Ottaway: I would have thought that the Minister would include a degree of humility and an apology in his answer. It is eight years since his predecessor stood at that Dispatch Box promising a new hospital in Purley. We are in desperate need of services in the south of our borough, so will he please give orders straight away to get on with this development and do so in such a way as to ensure that if there is a change of Government in a few months' time, the orders will stand and the development will still go ahead?

Mike O'Brien: I am not surprised that the hon. Gentleman is anxious to avoid there being a change of Government, because we know that the new announced policy of his party may well mean that he will not get his hospital-I understand his concern.
	I shall now deal with the specific point about Purley hospital. As the hon. Gentleman knows, it was to be developed by a private sector company called Translloyd, but as it was unable to get a retail developer on to the site, the original plan was declared to be no longer feasible. Translloyd still owns the site and Croydon council is trying to find ways to release it for development. As he knows, the problems arose in 2008.

NHS Funding

Sally Keeble: To what extent levels of deprivation in local communities are taken into account by his Department in determining NHS resource allocations.

Mike O'Brien: As my right hon. Friend the Secretary of State has said, deprivation is a key feature of the NHS funding formula, which reflects both deprived and older people's needs in health care. We are clear that we want to ensure that that remains part of the formula.

Sally Keeble: I am grateful to my right hon. and learned Friend for that answer. I wanted to ask him further about the deprivation experienced by pensioners in the community in view of the very tragic deaths of two of my constituents, Derek and Jean Randall, in quite appalling circumstances. In view of my lack of confidence in some of our local arrangements, will he ensure that his Department has very careful national oversight of the local review of the case that is going to take place? Will he ensure that any lessons that can be learned that apply nationally are rolled out and applied nationally to ensure that no one else has to endure something like this? It is completely inappropriate in 21st century Britain that pensioners should experience such ordeals and should die such very tragic deaths.

Mike O'Brien: My hon. Friend is right. The case of Derek and Jean Randall is deeply tragic and we need to ensure that it is fully and properly investigated. I understand that a local multi-agency safeguarding board is undertaking a serious case review. I cannot comment until all the details are available-I have only read the front page of the  Daily Mail today, and it certainly seems a very worrying case. I want to ensure that this is fully investigated and that the results of the investigation are open. We will take a keen interest in the outcome and we want to ensure that any lessons that need to be learned are learned and that this sort of thing does not happen in the future.

Nicholas Winterton: Will the Minister tell the House whether the level of deprivation featured in the decision of the Department of Health to end the reciprocal health agreement with the Government of the Isle of Man? That agreement, which has been in place since 1948, is to be ended on 1 April this year. This is a very serious matter. May I have an answer?

Mike O'Brien: My right hon. Friend the Secretary of State will be meeting the Manx Minister in due course. We are not minded to change our policy on this. We take the view that our approach is the right one, and we will see what the outcomes are of the discussions with the Isle of Man.

Pharmacies

Graham Allen: If he will bring forward proposals to protect small pharmacy businesses from the effects of in-house pharmacies opening in supermarkets.

Gillian Merron: Independent pharmacies play an important and valuable role in providing pharmaceutical services. The NHS pharmaceutical services regulations treat all providers equally and there are no plans to change this.

Graham Allen: After a powerful campaign by the local community in my constituency, we were able to keep open Mr. Mistry's pharmacy, a local community pharmacy in my constituency, and Tesco withdrew its application to have an in-house pharmacy nearby. That is a good outcome for everyone in the community, but will the Department pull together some of the big supermarkets and the representatives of the pharmacy associations to discuss a sensible way forward so that such battles do not take place and local communities keep effective pharmacy services?

Gillian Merron: Pharmacists such as Mr. Mistry and many others up and down the country provide an excellent service to their local community, and my hon. Friend is quite right to campaign for a vibrant and diverse range of pharmacies. The truth is that the public value and use a range of provisions from supermarkets through to local pharmacies. Perhaps we can look to the provisions of the Health Act 2009, which will mean that the local NHS will be able to assess local needs and to meet them.

Hywel Williams: Does the Minister accept that there is a particular problem in rural areas, where the predatory practices of supermarkets might lead to the closure of pharmacies, depriving large geographical areas that are thinly populated? Will she take some steps specifically in that case?

Gillian Merron: The provisions of the Health Act will mean that the local NHS will be able to assess local needs, to fill the gaps and to monitor quality better. This is all about being driven more by the needs of the patient, whether they are in rural or urban areas, than by those of the provider of the services, as is the case at present. It is important to say that the supermarket sector provides some 5 per cent. of the market, whereas the larger contractors-such as Boots, the Co-op and Lloyds pharmacy-provide something like one third. There is no evidence that supermarkets are driving the smaller operator out of business.

Ambulance Turnaround Times

Edward Vaizey: What his most recent assessment is of the performance of NHS ambulance trusts regarding ambulance turnaround times; and if he will make a statement.

Mike O'Brien: Information on ambulance turnaround times is not collected by the Department, so in a sense we do not have that information. There is quite a wide range of data in relation to how long people get for lunchtimes and so on. We do, of course, keep response times and that sort of data.

Edward Vaizey: Does the Minister agree with Unison that the new eight-minute target for ambulance response times could put patient lives at risk by forcing ambulance crews to go from two to one? Would it not be better to find a bottom-up solution and force ambulance trusts to publish their data on websites so that the public could see individual ambulance response times?

Mike O'Brien: We certainly take the view that improving the response times of ambulances is very important. That is why the new response times have been put in-to take away the period of time for the call, which was one of the issues causing delays. In the past, the clock did not start ticking until after the call was put through, whereas we now include the time from the point at which the call is made. That is a better reflection of the standard of service that patients get. As for publishing every ambulance time, I think that might be somewhat bureaucratic, but information can now be provided in general terms about average ambulance times.

Topical Questions

Laurence Robertson: If he will make a statement on his departmental responsibilities.

Andy Burnham: Today, Sir Michael Parkinson has published his report on his year as the national dignity ambassador. I thank him on behalf of the Government for the time that he has given to raising awareness of the issues that affect us all and for the personal insight that he has brought to considering how we can improve care for older people. The fact that there are now 12,000 dignity champions working at a local level illustrates the difference that Sir Michael has made, and we will look to build on that.
	As the cold weather continues, staff across the NHS, particularly ambulance services and accident and emergency staff, have been working extremely hard to minimise the impact on patients. Although it is under greater pressure, I can tell the House that the NHS in all parts of the country is coping well. I am sure that Members on both sides of the House will want to join me in thanking health and social care staff for their efforts to help to protect vulnerable people at this time.

Laurence Robertson: I certainly endorse the last part of the Secretary of State's comments. May I bring to his attention the rather long waiting list that people who suffer from acute back pain have to go through before they see a consultant? As a long-standing and regular sufferer myself, I know that it is no laughing matter. The waiting time is such that if the problem is serious, it can progress a great deal in that time. If it is a less serious problem, it will no doubt have corrected itself in that time. Whichever situation applies, the waiting time is far too long. Can the Government do anything about that?

Ann Keen: The hon. Gentleman is right to say that back pain creates many problems, not just for the people involved but for the economy in general. That is why we now have a system of self-referral to a physiotherapist. I believe that all patients should have that right. We will also be looking at the development in the chief medical officer's recent report on pain clinics and how chronic pain is managed, including how chronic and acute back problems can be managed.

Hugh Bayley: In 1997, there were 284,000 people waiting more than six months for NHS treatment. What is the figure today, and what are the Government doing to prevent the situation from sliding back to the bad old days when the Conservatives were in power?

Mike O'Brien: My hon. Friend is quite right: we must prevent a drift back to the bad old days. In his area, Yorkshire and Humberside, in 1997, there were 26,719 people waiting more than 26 weeks. In November-these are the latest figures I have-the number was zero, so nobody was waiting. Whereas we will lock in that achievement as a right, the Conservative party would remove the guarantee. The Conservatives will have to explain to the public why they would do that.

Evan Harris: This morning, I faxed to the Public Health Minister's office some documents provided to me by the investigative journalist Jane Symons. Those documents show that the Human Fertilisation and Embryology Authority has not only spent millions of pounds pursuing, ultimately failingly, an individual clinician, but that the new chief executive who was brought in to sort out the problem had argued for an externally led inquiry last year. Why has that inquiry not happened? Does the Minister have any proposals to ensure that we know why millions of pounds of taxpayers' money was wasted in that way?

Gillian Merron: I am grateful to the hon. Gentleman for his courtesy in forwarding the documents, but I remain of the view that it would not be in the public interest to pursue an inquiry. There have been a number of significant changes at the authority since the time of the incidents covered in the memo, which I would be happy to write to him about. However, the interim chief executive has acknowledged that the authority is not free from criticism, and there is to be an internal governance review to consider all these issues.

Brian Jenkins: Given the very harsh winter that we are suffering at present, I have no doubt that my right hon. and learned Friend the Minister of State will recall the annual winter crises that we used to have more than a decade ago. People-mainly elderly people-were lying on trolleys in our hospitals for days before they died, after which their bodies were stuffed in refrigerated vans outside. What can he do to assure me that those crises will never return to this country, and how do we manage to cure that problem?

Mike O'Brien: Elderly people are of course now able to benefit from flu jabs, winter fuel payments, pension credits and, when it gets very cold, cold weather payments. In 1997, the NHS spent £426 per person on health, but today it spends £1,612. Whereas the Tories were frozen in the ice of their own indifference to older people, this Government actually care.

Andrew Pelling: Will the Minister match the very helpful answer that I had from the Minister of State at the Department for Transport on Thursday about how that Department and the Department of Health have been working closely together to provide the preventive medicine of road gritting, so that hospitals receive fewer people with fractures? In Croydon's Mayday hospital, fractures are currently up 40 per cent., but at the beginning of the crisis they were up 316 per cent.

Mike O'Brien: It is certainly the case that we need to ensure that the NHS works with local authorities to make sure that ambulances can get through, that ambulance crews can get to their ambulances, and also that the service is geared up to deal with the various problems arising from the recent very bad weather. We need to make sure that the various bodies work together, and the information that we have so far suggests that they are doing so.

Tom Levitt: The Autism Act 2009 was a great success for Back Benchers across the House, in co-operation with a caring and receptive Government. It calls for the autism strategy for helping adults with autism and Asperger's syndrome to be published. Will my hon. Friend the Minister of State make sure that it is published before we are diverted by other matters a little later in the year?

Phil Hope: I am grateful to my hon. Friend for his comments. The 2009 Act was a landmark piece of legislation, which was passed on a cross-party basis. I can reassure him that the autism strategy is due to be published before 1 April this year. Discussions on the strategy are going on as we speak. Indeed, the external reference group that has been advising us on it-and which involves service users, family carers, voluntary organisations, professionals and so on-met only today to consider its contents. The strategy will be backed up by a clear delivery plan, and further guidance for health and social care providers later this year. So yes, the Government are going to deliver on autism.

Richard Taylor: What does the Secretary of State consider will be the most effective way to reduce binge drinking in the young?

Andy Burnham: I recognise that the public mood is changing when it comes to alcohol-not just binge drinking, but the general intake of alcohol by the wider population. There is rising public concern, as reflected in last week's report from the Health Committee. The hon. Gentleman will remember the report on obesity that was published when I used to serve on the Committee with him. That report changed the nature of the debate, and it is possible that last week's report will come to do the same. We are looking at the next steps on tackling alcohol, and considering the consultation on the mandatory code and the measures to combat the irresponsible promotion of alcohol. We are also considering going further on labelling, but of course I remain open to further discussions with him and the Committee on how we may go even further.

Several hon. Members: rose -

Mr. Speaker: Order. I want to get several more colleagues in, so I need very short questions and short answers.

Andrew MacKinlay: I thank the Secretary of State for agreeing to meet the Chief Minister of the Isle of Man about the future of the reciprocal health agreement. Will he get his officials to look particularly at the impact that that decision could have on his and my constituents who are TT enthusiasts-motorcyclists-and the impact that it would have on NHS North West if the Isle of Man took its elective surgery purchases away from there to Edinburgh, Belfast or Dublin?

Andy Burnham: As the Minister of State, my right hon. and learned Friend the Member for North Warwickshire (Mr. O'Brien), mentioned a moment ago, I have agreed to meet the Manx Health Minister to discuss these issues. As a north-west MP, I know that the island has a long-standing relationship with the north-west of England and its health service, and I will commission the work that my hon. Friend mentions on the potential effect of purchasing being switched. I am not minded at present to change our position but I will, of course, listen to what the Minister has to say.

Tom Brake: I thank the Minister of State, the right hon. and learned Member for North Warwickshire (Mr. O'Brien), for his support for the Better Healthcare Closer to Home project so far. Is the Department on track to complete the review of the project by the end of this month, and is the Treasury ready to pick up the baton immediately afterwards?

Mike O'Brien: We want to move the project on as fast as we reasonably can, and we hope to be able to get things sorted through by the end of the month. Let us remember that there are some local decisions to be made over which we do not have entire control, but the objective is to get the project moving.

Alison Seabeck: Has my right hon. and learned Friend received any recent requests from the Ministry of Justice for up-to-date estimates of the increase in the number of secondary pleural plaques in order to enable it to come to a decision on a compensation package?

Mike O'Brien: My hon. Friend has indicated that she wants to ensure that we are working with the Ministry of Justice on the matter. I assure her that we will be in regular contact in future with the Ministry of Justice to develop the Government's strategy as a whole in relation to pleural plaques.

Paul Burstow: I strongly endorse the question asked by my hon. Friend the Member for Carshalton and Wallington (Tom Brake), but may I ask the Minister about another matter, which is related to autism, which has been raised already? Eight out of 10 GPs confirm that they feel they need more training so that they can better understand autism and care for the condition better. What will the Government do to ensure that there are sufficient resources, will and determination to deliver that extra training?

Phil Hope: The consultations that we have had and the development of the strategy, which we will publish shortly, have made clear the importance of the GP understanding, knowing, diagnosing and being able to refer on appropriately individuals who may have any condition on the autism spectrum. An important part of the strategy that we wish to pursue is the training of professionals-not only GPs, although they are a key and vital part of the front-line services. Training of professionals and raising awareness among professionals of what autism is, how to respond to it and what services are available is a critical part of the strategy going forward.

Natascha Engel: At the last Health questions, I raised the issue of lab technicians who make dentures and crowns for dentists, and I thank my hon. Friend the Under-Secretary of State for agreeing to meet me and my constituent, Andrew Taylor, this afternoon. In advance of that meeting, can she confirm what her Department is doing to encourage UK dentists to use UK lab technicians?

Ann Keen: I look forward to meeting my hon. Friend in the next half-hour to discuss that in more detail with officials.

David Borrow: It is estimated that there are more than 20,000 men and women in this country who are HIV-positive, and who have not been tested or diagnosed and therefore do not know that they are HIV-positive. Does my hon. Friend agree that the Department should aim to reduce that figure by at least 50 per cent.? What action is the Department taking to achieve that objective?

Gillian Merron: Obviously, early identification is crucial. We have talked at some length with the all-party group on AIDS about measures that we can take, and I am happy to continue those conversations.

Tim Loughton: I have a young mum in my constituency dying of breast cancer and desperate to prolong her life, with two young daughters who rely on her. She has been prescribed Herceptin. It is not working because of the size of the molecules. She is told by her specialist that Lapatinib would work for her. It costs less than two thirds of the cost of Herceptin, yet she is being denied it. I wrote to the Secretary of State on 19 November and I have chased him twice since, but I have still not had a reply. Will he please look at the matter urgently?

Mike O'Brien: I have indeed been looking into the issue of Herceptin, and I am aware of the way in which the National Institute for Health and Clinical Excellence has approached it. These are important and difficult issues, and I can assure the hon. Gentleman that, if he has an outstanding letter on this matter, I will chase it up with my officials.

Mark Harper: I was listening to what the Minister said about ambulance response times. They are of course important, but more important are patient outcomes-whether a patient lives or dies and what actually happens to them. What progress is the Department making on ways of measuring patient outcomes so that ambulance trusts can be more sophisticated in the way they deploy their resources?

Mike O'Brien: I have heard the term "outcomes" being bandied about, but it is not always entirely clear what the Opposition mean by it; they seem to have different views of what it means at different times. As far as the Government are concerned, the important thing is that we ensure that the ambulance service is there when patients need it, that its response times are within the criteria that we have set for it, and that targets are met. The Opposition would get rid of the targets that save lives; we would keep them.

Paul Flynn: Was the threat of 65,000 British swine flu deaths an unscientific exaggeration that has cost the country dearly, not only financially but in terms of stress and distorted NHS priorities?

Andy Burnham: We had to take every possible step to keep the country safe through what was declared a world health pandemic, not by this Government but by the World Health Organisation. We saw the events in Mexico in the spring, followed by the exceptional spike in flu cases in this country in the summer. There were understandably high levels of public concern, and I make no apology for making all the necessary preparations to keep the public safe through that. We have come through the pandemic because of the strength of the plans and preparations that this Government put in place.

Christopher Fraser: Does the Secretary of State agree that, to allow waiting times for cancer treatment to be monitored, specific data should be collected individually for each of the most common cancers, so that a better picture can be seen? I was not sure from his previous answer.

Andy Burnham: I refer the hon. Gentleman to the report issued by the national cancer director at the end of last year. He will see in it the publication of data, primary care trust by primary care trust, that have not been published in this form before. The report shows how many patients are being referred on the two-week urgent referral pathway, and there is a whole wealth of data on survival rates. I am always prepared to go further, however. The complaint from the Opposition is always that we collect too much data, but if the hon. Gentleman wants me to go further, I am prepared to consider doing so.

Linda Gilroy: On Saturday, I met the Plymouth and South Devon Dystonia Support Group, which was celebrating its first anniversary. Will the appropriate Minister please meet me to discuss research and development, and treatment and support for that group of sufferers?

Mike O'Brien: Yes.

Tony Baldry: The Minister of State, Department of Health, the right hon. and learned Member for North Warwickshire (Mr. O'Brien), made a welcome announcement over the Christmas break about payments to the Thalidomide Trust. Did I miss the statement to the House confirming that announcement? The news was very welcome, but I would just like to know whether it is now on the record.

Mike O'Brien: I hope that I might be able to say a bit more about that in due course.

Greg Mulholland: The Secretary of State knows that I have raised concerns about the awarding of the contract for the Eccleshill independent sector treatment centre in Bradford. He will now be aware that the decision to award that contract has been suspended for another five months. I have said that it should not go ahead in the light of the concerns, and that there should be a public consultation. Can he tell me why that decision was made, and whether we will now get that consultation?

Mike O'Brien: We are still looking at that matter and I hope that I will be able to give the hon. Gentleman a fuller answer on the details in due course.

Peter Bone: Earlier, the Secretary of State referred to the Health Committee's report on alcohol, and said that he was open-minded about it. Does that mean that the Government are prepared to consider minimum pricing for a unit of alcohol?

Andy Burnham: I suggest that the hon. Gentleman look at this Government's record on tackling tobacco over the past decade. That shows that we will continue to take the bold steps necessary to improve the health of the nation. I have said that we will do more on labelling, and on our mandatory code. Pricing is of course a key issue in this debate. I do not know whether he has concluded that minimum unit pricing is now essential, but we must also consider the issues of deep discounting and selling below cost price, which also form part of the equation. This is a time not for shouting across the Floor of the House but for both parties to address the issues and to ask whether the public mood has changed and whether we need to take a different approach to alcohol in our communities.

Andrew Stunell: The Royal British Legion says that little effective progress has been made on the veterans' NHS priority treatment scheme. What steps is the Minister taking to ensure that PCTs and hospitals monitor progress on this and that veterans get the care to which they are entitled?

Mike O'Brien: Yesterday I was able to make an announcement, together with Combat Stress, one of the veterans' organisations, to ensure that we deal in particular with some of the issues that arise as a result of people being involved in combat. We also want to ensure that GPs are more fully aware of the rights of veterans. We have asked that all PCTs ensure that they have somebody at a director level who is responsible for ensuring that this information gets out, and that strategic health authorities have someone in place at a director level-on the board-who is responsible for ensuring that this sort of information gets out and that veterans, who have served their country, get the service from the NHS that they deserve.

Mr. Speaker: Order. I think that the inquisitorial appetite has been satisfied.

Point of Order

Stephen O'Brien: On a point of order, Mr. Speaker. While you are in the Chair before the House goes into Committee, I wanted to ask for your guidance. The Minister of State, Department of Health, the hon. Member for Corby (Phil Hope), has written to my hon. Friend the shadow Secretary of State for Health stating that the costings in the published impact assessment on the Personal Care at Home Bill, which we are about to consider, are wrong. On 5 January, he told me in a parliamentary answer:
	"A one-off transition cost of £335 million is set out in the impact assessment".-[ Official Report, 5 January 2010; Vol. 503, c. 277W.]
	On 8 January, he told my hon. Friend that, strictly speaking, the one-off cost should be zero. Could you guide me, and indeed the rest of us, Mr. Speaker, as to whether it is acceptable under our rules for the House to be considering a measure today, particularly on the Floor of the House, when it does not have the full information before it, and despite the Government's having had adequate notice to correct their errors and to ensure that they furnished us with the information in advance of the debate?

Mr. Speaker: I am grateful to the hon. Gentleman for his point of order. I do not know whether a Minister present wishes to say anything; he or she is under no obligation to do so. The hon. Gentleman has registered his point very forcefully on the record. However, I hope that he will understand when I say that on the strength of his 12 and a half years' service as the hon. Member for Eddisbury, he knows that that is a perfectly legitimate point of debate but it is questionable whether it constitutes a point of order.

BILL PRESENTED
	 — 
	Sustainable Energy (Local Action) bill

Presentation and First Reading (Standing Order No. 57)
	Alan Simpson, supported by Mr. John Gummer, Mr. Gordon Prentice, Andrew Stunell, Mr. David Amess, Mr. Andrew Dismore, David Howarth, Mark Durkan, Andrew George, Mr. David Drew, Bob Russell and Steve Webb, presented a Bill to promote energy efficiency; to require specified bodies to publish sustainable energy plans; to make provision for the transfer of functions to principal councils; and for connected purposes.
	 Bill read the First time; to be read a Second time on 30 April ,  and to be printed (Bill 46).

Mr. Speaker: I apologise to the hon. Member for Eddisbury (Mr. O'Brien) for extending his service in the House by two years. He has been here for 10 and a half years; I will not say that it feels like 12 and a half.

Video Recordings (Exemption from Classification)

Motion for leave to introduce a Bill (Standing Order No. 23)

Andrew Dismore: I beg to move,
	That leave be given to introduce a Bill to extend the criteria under which music and sports video works and documentaries lose their exemption from classification.
	Although we passed-or perhaps I should say re-passed-the Video Recordings Bill last week, for technical reasons of urgency it was not practical to propose amendments at that stage. However, some small but highly significant amendments are needed to ensure a more robust regime for child protection. As chair of the Joint Committee on Human Rights, I am an ardent supporter of the right to free speech and expression, but I acknowledge the need for a system of regulation that protects children from harmful content in film, videos and DVDs.
	At the current time, we have a very effective system of classification. The British Board of Film Classification undertakes extensive research into public opinion about what is acceptable content. The BBFC also takes account of research evidence and the advice of psychologists, health care professionals and the police, among others, to produce guidelines, which are updated every four years, that ensure that the content that reaches children in the UK legally in the form of film, DVDs and videos is of an age-appropriate nature and is not harmful to them.
	However, there are gaps in the current regime covering videos and DVDs under the Video Recordings Act 1984-the VRA-and that is what my Bill aims to address. The VRA permits a number of exemptions to the classification regime. Currently they relate not only to video games but to other video works such as music and sports videos. When the Act was passed in 1984, the assumption was that such works were unlikely to cause any concern. My right hon. Friend the Secretary of State for Culture, Media and Sport has recognised that the regime for video games needs to be updated, and the Digital Economy Bill, currently in the other place, is intended to do that. As an aside, it is important to note that in doing so it should in no way undermine the classification regime for linear-non-interactive-material by confusing the responsibilities of the BBFC and those of the Video Standards Council, which is intended to be the statutory authority for classifying video games.
	Except in relation to video games, exemptions are unfortunately not addressed in the Digital Economy Bill. That is a missed opportunity and the reason I have chosen to bring forward my Bill, which would extend the criteria under section 2 of the VRA to result in specified video works losing exemption from classification. At present, exemption can be claimed for video works such as music and sports videos, which can be very popular with children. Those videos can then be sold to children perfectly legally, even if they contain material that is potentially harmful. My Bill is not intended to extend the VRA to all such exempted works, only to those that contain content that is potentially harmful, such as graphic violence, sexual content falling short of actual sexual activity, imitable dangerous behaviour and drug use. Harmless video works of football matches or artists from the "The X Factor" would remain exempt.
	I have seen some of the less benign sport and music videos myself. For example, the Ultimate Fighting Championship's "UFC Best of 2007" is a combat video featuring martial arts and other fighting techniques. It is available on the high street to any child because its distributor has, quite legally, claimed exemption from BBFC classification under the VRA. It therefore carries no age rating or consumer advice. It contains close-up images of bloody and sustained head blows, which are replayed in slow motion from every conceivable angle to ensure that the best possible view is given of the moments of impact.
	Another work that I have seen is Mötley Crüe's "Greatest Video Hits", which features topless lap dancing and a George W. Bush lookalike in a limousine with a prostitute. The packaging carries an E for exempt rating. Gorgoroth's "Ad Majorem Sathanas Gloriam" features bloody bodies being crucified and a sheep's head on a spike. The American band Slipknot is hugely popular with children, some as young as 10, as well as with teenagers. As expected from the band's reputation, its 10th anniversary DVD features strong content designed to offend parents. Among the most concerning images are those of the consequences of self-mutilation carried out by two teenage girls who have carved the name "Slipknot" into their arm and torso respectively, yet the video carries a letter E in a green triangle indicating that it is exempt from VRA classification.
	Those are all works that parents could and should legitimately expect to be regulated, yet under the current legislation they can all be sold legally without any age restriction. Indeed, it is worth noting that some of that material is rated and age-restricted in other countries. For example, the German film classification body rated the Slipknot DVD as suitable only for those aged 16 and above and the Gorgoroth DVD as suitable only for adults.
	Trading standards officers would welcome the power to prosecute the supply of such unclassified works, but believe that the current legislation exempts them because, for example, they do not contain gross violence, which is a very high threshold, or actual sexual activity. Local Authorities Co-ordinators of Regulatory Services, which represents local authorities on this matter, and the BBFC both support my Bill's minor amendments to section 2 of the VRA in order to broaden the criteria that determine when a video work loses its exemption. Such amendments would enable law enforcement agencies to prosecute the supply of video works that are currently exempted, to protect children from potentially harmful media content.
	I understand that the Government believe that the enforcement authorities can already take such action. However, the view of those who actually have that responsibility is that they cannot, because of the very high bar set by the VRA in order to lose an exemption. For example, had the Slipknot DVD shown the two girls actually in the process of mutilating themselves with a sharp blade, that may well have constituted gross violence under the VRA, but showing the scars after the event almost certainly does not constitute violence sufficient to lose exemption from classification.
	Many responsible members of the home entertainment industry voluntarily seek classification certificates for exempted video works that contain such potentially harmful material. Members of the British Video Association-the BVA-do so even though they are not legally obliged so to do. Their actions in this regard are to be commended. I understand that BVA members support amendments to the Video Recordings Act that would make it a legal obligation on distributors to have potentially harmful material classified, as proposed in my Bill, but there are distributors who do not take the same responsible attitude. That lack of a level playing field serves only to add to consumer confusion.
	A parent looking through a shelf of music or fighting videos, some of which are rated 15 or 18, but some of which are marked E for exempt, is likely reasonably to draw the conclusion that the E video is suitable for younger children. Otherwise, the parents would assume, surely it would have been classified. Yet often, the content of E for exempt videos is virtually identical to or worse than that of an age-restricted product. I would therefore like to urge my hon. Friend the Minister to support this Bill.
	To conclude, this Bill is aimed at modernising the VRA and improving consumer-and most particularly-parental empowerment, to protect their vulnerable children from harmful video material. I commend this Bill to the House.
	 Question put and agreed to.
	 Ordered,
	That Mr. Andrew Dismore, Mike Gapes, Rob Marris, Mr. Virendra Sharma, Mr. Edward Timpson, John Austin, Ms Karen Buck, Clive Efford, Mr. John Whittingdale, Judy Mallaber and Keith Vaz present the Bill.
	Mr. Andrew Dismore accordingly presented the Bill.
	 Bill read the First time; to be read a Second time on Friday 26 February and to be printed (Bill 45).

Personal Care at Home Bill

[Relevant documents: The uncorrected transcripts of oral evidence taken before the Health Committee on 3 December 2009 and 7 January 2010, on Social care, HC 22-iii and iv.]
	 Considered in Committee

[Sir Alan Haselhurst  in the Chair]

Alan Haselhurst: In view of the selection of amendments to clause 1-the only substantive clause-I am not minded to allow a debate on clause stand part. That is open to reconsideration if there is any great gap in the discussion. I have tried to select a wide range of amendments and I hope that that will enable all the main issues to be debated.

Clause 1
	 — 
	Free provision of personal care at home

Stephen O'Brien: I beg to move amendment 9, page 1, line 7, leave out from 'in' to end of line 8 and insert-
	'(i) extra care housing;
	(ii) sheltered accommodation;
	(iii) warden controlled accommodation;
	(iv) care home without nursing;
	(v) care home with nursing.'.

The Chairman: With this it will be convenient to discuss amendment 10, page 1, line 8, at end insert-
	'(2A) After subsection (4) insert-
	"(4A) In subsection (4) "care home"-
	(a) in relation to England and Wales, has the same meaning as in the Care Standards Act 2000 (c. 14), and
	(b) in relation to Northern Ireland, means a residential care home as defined by Article 10 of the Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003 (S.I. 2003/431 (N.I. 9)) or a nursing home as defined by Article 11 of that Order."'.

Stephen O'Brien: The background to this Bill is the fact that social care provision is currently means and needs-tested. The needs test places an individual in one of four categories-critical, substantial, moderate or low. The mean test assesses assets. If someone has more than £23,000, including property, they are liable for the full cost of their care. Those who have more than £14,000 are liable for some of the cost. After the assessment of needs, and if someone is below the means threshold, the council will agree a care plan with them. For those in the critical or substantial groups, that may include entry to residential care; otherwise, care will be provided in the domestic setting. Free personal care will be targeted at critical needs only through regulations to be passed on the back of this Bill.
	I hope that that was a useful scene-setter, because we should be under no illusion about what is happening in the Chamber today. The Secretary of State has said, in relation to this group of amendments and the Bill-it is effectively a one-clause Bill, because its substantive operation is in only one clause-that he wants to make social care one of the top three election messages. He did not say "priorities"; he used the word "messages".
	The Prime Minister announced the policy under discussion in his address to the Labour party conference, where it was cleared with only 20 minutes to spare. The policy goes utterly against the grain of the Government's Green Paper on social care, not least because it is being funded from general taxation. The impact assessment on costings covers only two and a half years, because the Government know that the expense will sky-rocket after that. It is perhaps some small consolation that the Government are behaving like a Government who may not be in office in the next Parliament.
	Nothing attests to the politics of the measure more than the fact that we are discussing it in a Committee of the whole House-a procedure normally limited to excessively controversial legislation, particularly legislation that is in free-vote territory. The Government are rushing the Bill through to prevent the fullest possible scrutiny. We will do our utmost to get through all the groups of amendments today, but I fear that that will be at the expense of the necessary wider scrutiny of the underlying issues of the policy behind the Bill. Another small consolation is that the fiercest attacks-certainly if the record to date is correct-will come from the Government's own side when the Bill continues its pell-mell progress in the other place.
	The Secretary of State has said that he wants to create an "unstoppable momentum" for reform of social care. This piecemeal measure, which affects around 270,000 people-not even 5 per cent. of social care users-has already put a spanner in the works of the Green Paper process, preventing the full publication of the costings, so Ministers claim. Making the Bill work will put a spanner in the whole process of reform which, I fear, is the social care legacy the Secretary of State is aiming to leave. That comes on top of the point of order that I just raised with Mr. Speaker, prior to you, Sir Alan, taking the Chair for the Committee of the whole House. The impact assessment was prepared in a way that has not stood the test of time-even in the weeks since the publication of the Bill.
	Amendment 9 would prevent care from being provided free of charge for more than six weeks to someone in any of the named institutions. It is deliberately a probing amendment, so that we can get to the bottom of the matter in the glare of the fullest scrutiny on the Floor of the House. I confess that we have had only smoke and mirrors from the Government on the matter.
	Amendment 10 simply defines a care home. The Northern Ireland proposal is not relevant, but why has the Minister gone for the convoluted phrase,
	"the provision of personal care to a person living in accommodation that an establishment provides to the person together with the care"
	rather than using a statutory definition that is already in force?

Stephen Ladyman: I am grateful to the hon. Gentleman for giving way at this early stage in his speech. Somebody living in "extra care" accommodation-one of the categories that his amendment would exclude-is by definition living in their own home and able to organise care services separately from the tenure of their own home. Even for the purposes of probing, what possible justification can there be for proposing to exclude "extra care"?

Stephen O'Brien: I am glad that the hon. Gentleman recognises that amendment 9 is a probing amendment. Quite genuinely, it probes the Government on the difficulty of their definition of home and the answer to the question what is a home. I hope he bears with me, because we will discuss the matter in some detail in relation to an amendment on transitional arrangements-I am sure he will immediately understand the connection between those and "extra care". The reason why "extra care" is particularly relevant is that the Government have chosen not to pick up the definition that already exists in statute, which was the point I was making when he helpfully intervened.
	I cannot remember where the hon. Gentleman was in his ministerial career at the time of the Care Standards Act 2000; he might not at that stage have reached the Health team. Section 3 of the 2000 Act, passed by this Government, defines care homes thus:
	"For the purposes of this Act, an establishment is a care home if it provides accommodation, together with nursing or personal care, for any of the following persons."
	They include:
	"persons who are or have been ill...persons who have or have had a mental disorder...persons who are disabled or infirm...persons who are or have been dependent on alcohol or drugs."
	However, an establishment is not a care home if it is
	"a hospital...an independent clinic; or...a children's home...or if it is of a description excepted by regulations."
	There is therefore already something in legislation that could have been helpfully used for the purposes of describing what is meant in the Bill by being in one's home or not in one's home. I hope that the hon. Gentleman will understand that the Government rightly need to be probed on that issue, because it will have a major effect on whether people qualify for the help that it is intended they should receive. Free personal care at home will be of significant interest to those who qualify for it and those who do not.

Joan Humble: Just to be helpful, I want to continue the discussion about extra care housing, which is referred to by amendment 9. The explanatory notes for the Bill specifically say that extra care housing qualifies under the new arrangements that the Government want to put in place. I am therefore bewildered that the hon. Gentleman should propose in his amendment to exclude extra care housing, because it can be the individual's home. I am listening with interest to his definition of residential care, but we also need to clarify what is meant by a person's own home, and the explanatory notes include a reference to extra care housing.

Stephen O'Brien: Given the way in which the amendments have been selected and the Chairman's strictures at the outset of consideration, I am conscious that, to stay in order in our debate on amendment 9, I shall have to postpone a more detailed discussion about extra care until our debate about transitional arrangements, which is where it will feature most strongly. I hope that the hon. Lady will bear with me, because the issue warrants discussion. However, as she will recognise, amendment 9 is a genuinely probing attempt to elucidate from the Minister, we hope, how we can get a much clearer and, more importantly, more secure definition of those who are likely to be eligible. After all, that is what will matter most to the people whom we are talking about, who are the most in need and, often, the most vulnerable.

Stephen Dorrell: Do not the two interventions that my hon. Friend has just taken illustrate a rather broader point than the narrow definitional point? The effect of his amendment 9 has been to draw the Committee's attention to those who are excluded from the category of people who benefit from the Prime Minister's election pledge. Should we not focus on why one group of people benefits from that pledge and why another does not? Those interventions illustrate the injustice of the new anomaly that, effectively, the Bill will create.

Stephen O'Brien: I am extremely grateful to my right hon. Friend, whose expertise and experience in this area are matched by none in the House and few outside it. We know the provenance of the Government's proposals as set forth in the Bill-we know that it was a rushed job, with only a 20-minute clearance time between decision and announcement at the Labour party conference-but even putting that to one side, he is quite right that it is vital to consider who is to be included. That question warrants proper scrutiny, because the fact that some people will be included means, by whatever definition is used, that the rest are excluded, and that will cause potential injustice.
	My right hon. Friend will find that that is so from our discussions on later amendments, although I am conscious of how difficult it will be to remain in order, because things are so tightly drawn, not least the selection of amendments. That has been extremely constrained by the deliberately tight drafting by the Government of the money resolution, to try to exclude discussion on the much wider processes promised in the Green Paper and suggested by others, who have made some extremely interesting and sensible proposals in considering the reform of the whole of social care, rather than one small aspect of it, relative to the overall demand. I suspect that my right hon. Friend's concerns will be most clearly addressed when we come to an important discussion on compliance-how we ensure retained compliance with the European convention on human rights and the ability of the Secretary of State to issue the certificate under the Human Rights Act 1998, as stated on the front of the Bill. I very much hope that my right hon. Friend will have the opportunity to look at that aspect when we reach that point.
	Building on what my right hon. Friend has just helpfully mentioned, the Bill attempts to cut out residents of care homes from eligibility for free care. Last year, 50,000 people-yes, fortunate people, but also hard-working people who have done the right thing in investing, perhaps through a mortgage, in their own homes-had to sell their homes to pay for their long-term care, notwithstanding the fact that some sales did not occur until after people had died. That applied under a system that is available, but not often taken up, concerning whether people sell at the time they enter care or, indeed, when they leave it-under the home protection scheme or whatever.

Stephen Ladyman: I want to ensure that the hon. Gentleman is not inadvertently misleading the Committee, as he has said-in his opening comments-that the means assessment for care includes people's savings and their property. That is not the case with this Bill, because it deals with people living in their own home, and the value of their own home is excluded from the means test in deciding eligibility for care. The value of one's home becomes a matter for the means test only when people are going to leave their own home and go into residential accommodation.

Stephen O'Brien: I am grateful. The hon. Gentleman is quite right that the words we use in this place matter greatly, but I think that when he checks the record he will find that in my introductory remarks I used the word "assets" rather than saying "their own home"-quite deliberately, because of the distinction that he has rightly pointed out. The question of one's own home becomes relevant only at the time when one is being adjudged by proper assessment criteria as needing to leave that home in order to go permanently-or where it is expected to be permanent-into a residential care or other home setting. As we go through these definitional issues, it is important to recognise that these are real situations often involving vulnerable people in emergency situations.

Tom Clarke: I have the feeling that we may have more time than the hon. Gentleman thinks; I cannot recall a clause being given a whole day for consideration, but we will make the most of the time we have. The hon. Gentleman is putting a quite serious amendment before the Committee, as it ranges from "extra care housing" all the way through to "care home without nursing" and "care home with nursing". If we were to endorse his amendment, what would be the implications, particularly financially, for local authorities?

Stephen O'Brien: I hope that the right hon. Gentleman has been listening-well, he has obviously been listening, but I hope that he heard my saying that this was a probing amendment, so the Committee will not have the opportunity to endorse it. As I said, it is deliberately intended to probe the Government's intentions on who should be included, as well as who should be excluded, as my right hon. Friend the Member for Charnwood (Mr. Dorrell) said. With great respect to the doubtless very thorough briefing prepared by Labour's backroom people, it would be helpful-particularly given that all the questions relate to the same issue-if it were recognised that tabling a probing amendment does not necessarily invite Members to pass it. The amendment was tabled as a probing amendment and it was designed to elucidate information from the Government. That is precisely the official Opposition's job.
	I have already mentioned that the real debate on the issue will take place when we reach the amendment dealing with transitional arrangements, so I am keen not to get deflected by being forced to answer a question that really requires an answer from the Government. It is thus for me to ask the Minister whether he is happy with the drafting of provisions intended to cut out residents of care homes altogether. Are there no grey areas or any difficult marginal issues? Is the Bill drafted in such a way and is the money resolution so tightly drafted as to make it explicit that people who have done the right thing could none the less be automatically excluded because they own their own homes?
	Is the Minister happy to put this issue on the backburner, since the Bill has thwarted the Green Paper's aim? The Minister has asserted outside the House that all this is consonant with the Green Paper process. On the contrary, it has thrown a spanner in the works of the process of examining social care as a whole. That means taking account of those who own their homes as well as those who do not, and those who have assets as well as those who have none. It means taking account of very different levels of care need, and of problems relating to the interrelationship between health and social care. Many Members have reflected their constituents' concerns in referring to efforts to persuade the NHS and social care providers to be a little more flexible at the margins in order to prevent the terrible difficulties that people experience in trying to gain access to appropriate care and support.
	I wonder why the Minister could not at least consider-we invited him to do so on a number of occasions-presenting this Bill in tandem with a measure similar to our home protection scheme. It would have been fine for him to claim authorship for it if he had wished. That would have dealt with the difficulties confronted both by homes and by those receiving care in them, as well as by those receiving care in a different setting. Is the Minister satisfied that what I hope he will accept is the somewhat clunky drafting of subsection (2) is strong enough to prevent a legal challenge?
	On Second Reading, we drew attention to the dangerous impact that the subsection could have on residential care supply. If people are given an incentive to invest in extra care at the expense of residential care, that could distort provision. There is also another issue of more immediate concern. I shall exaggerate it for the sake of the argument, but I hope the Minister will accept what I say in the spirit in which it is meant. The whole point of scrutinising legislation is to ensure that a Minister has no defence if he subsequently says that the consequences of that legislation were unintended. If at this point I describe the problems and mischief that the drafting allows, and if those problems and mischief indeed come to pass, it will be wholly legitimate for me to say, "No, Minister, I warned you, and it was therefore entirely intended for this to go wrong", and the Minister will have no defence.
	When a care home owner wakes up on the day that the Bill is passed and seeks to outsource provision to a company that he or she wholly owns, will it still constitute care and accommodation provided by "one establishment"? What, in fact, is the legal definition of "establishment"? Can the Minister confirm the possibility of a loophole in the legislation? He has confirmed to me in a written answer that
	"It is open to any residential care home to reshape their service".-[ Official Report, 8 December 2009; Vol. 502, c. 281W.]
	Will he also tell us the potential cost of the exploitation of such a loophole to the taxpayer? What if 100 per cent. of those in care homes with critical care needs became eligible for free personal care? I would have hoped that if the Minister could not answer that question now he might write to me, but he has already said that he is not prepared even to do that.
	The legislation was drafted in haste on the basis of a back-of-the-envelope impact assessment. The Minister has already confessed in writing that that impact assessment was wrong and needs to be corrected. It consists almost entirely of estimates. Given the mess that the Labour party has made of our public finances, it is more important than ever for the Committee to be informed of the potential liabilities of the taxpayer should there be loopholes in the Bill.

Stephen Ladyman: I can probably find common cause with the hon. Member for Eddisbury (Mr. O'Brien) in certain respects. I understand his desire to probe the Government and secure greater clarity. As was observed by the right hon. Member for Charnwood (Mr. Dorrell), a former Secretary of State, it is plain that at some point the Government will have to go further. I see no moral justification for excluding a group of people with fairly serious care needs from Government help, whether they are in their own homes or in residential accommodation. At some point in the near future, we will require a personal care not at home Bill to address that need.
	I might part company from the hon. Member for Eddisbury on this point: he and his party have proposed the idea of a home protection system, under which, for a fee, the totality of a person's residential costs will be met. I believe that that would create a strange precedent, because for the first time an individual in this country would not be responsible for providing their own board and lodging. It has always been a principle that we are all responsible for providing our own board and lodging. Even if we have to pay for it out of benefits, that is still taken into account. The Opposition's solution to the problem would go against that principle.
	In probing the matter before us, the hon. Gentleman has set running some hares that perhaps need not be set running. I am particularly concerned about the fact that he is attempting to exclude extra care housing, because I believe that it is a model for the provision of care for older people in the future. Indeed, the huge majority of older people tell us they would aspire to such an arrangement were they to develop a care need because it means that they could live in their own accommodation.
	If the hon. Gentleman looks at the Department of Health website, he will find a clear definition of extra care housing, not least in the guidance for a competition in which developers were invited to bid for an £80 million fund to build extra care accommodation. One of the key elements of the definition is that the individual lives in their own home. They might have bought their extra care accommodation or be living in it as a tenant, but they will have security of tenure; they will have self-contained facilities so that they can cook and have access to their own bathroom and sanitary facilities; they will have their own front door that they can close to the world if they so wish, and they will be able to arrange their care needs themselves.
	The current system of means-testing people has the added advantage that, given that the accommodation will be the person's own home, the value of that home cannot be taken into account in the means test. The person might be looking to protect some of their savings, and that is a good way of preserving equity and passing it on to children-that might be important to them. I believe passionately, therefore, that extra care housing is a model that we need to promote. I believe that the Government have accepted that, and until we started debating the Personal Care at Home Bill and amendments to it, I always thought that the Opposition wanted to promote it as well. However, in the light of Second Reading and-on the face of it-amendment 9, I am now seriously worried about whether they understand the nature of extra care housing and its importance in the future.

Stephen Dorrell: Is the hon. Gentleman not missing the point? We all agree that the desirable developments being debated represent the direction of travel that we should be encouraging. However, given the artificial divide in such services that the Government are creating, my hon. Friend the Member for Eddisbury (Mr. O'Brien) was seeking to establish on which side those listed in the amendment will fall.

Stephen Ladyman: I understand the purpose of the probing amendment, but I would be less worried had the shadow Secretary of State not shown on Second Reading what to my mind was a vague understanding of what extra care housing is all about. He seemed to misunderstand completely the function and nature of extra care accommodation. I became doubly worried when I read amendment 9 and saw that once again the Opposition were seeking to list it as one type of accommodation that should perhaps be excluded from free personal care.
	I was reassured to hear the hon. Member for Eddisbury say that this is a probing amendment and that he did not intend to exclude extra care from the provisions. I look forward to engaging with him later in the debate about transitional arrangements when perhaps we can explore the matter a little more, and I encourage my hon. Friend the Minister, when he responds to the amendment, to provide the clarity that the Opposition are seeking about the types of accommodation in which one would be eligible, under the Bill, for free personal care, and to reaffirm the Government's support for extra care accommodation. If that is his response to the amendment, I hope that later in the day we might hear an acknowledgement from the Opposition that they also understand the importance of extra care, and that they, too, will support it in their future policy.

Greg Mulholland: Although I am pleased that we are having the Committee stage of a Bill on social care, I must begin by saying that the Liberal Democrats, too, have real concerns about the timing and process in respect of this Bill. The Bill has one clause and covers less than two sides of A4 paper. The way that it was announced was regrettable; it was announced not to the House, but to the Labour party conference. It is also only one piece of the jigsaw in terms of the great social care crisis. It was announced mid-Green Paper consultation and pre the White Paper that is supposed to be published in a few years, and came with a clearly inadequate impact assessment. Regardless of what the policy is, this is, as Lord Lipsey said,
	"a very bad way to do policy".
	Turning to the amendments, it is very important that we start with accurate definitions, not only of what is a care home, but of what we mean by personal care. I regret that the amendments that were selected do not include one that probes what we mean by personal care. An understanding of that definition is even more fundamental than what we mean by people living in their own homes, or care homes. I draw the House's attention to the detailed and interesting definition of personal care suggested by Help the Aged and Age Concern, and I regret that we will not get a chance to debate that.
	We must also look at the experience in Scotland-at the situation that has developed there arising from a lack of clarity about what is meant by personal care. This Bill presented us with a great opportunity to look again at, and clarify, what we mean by personal care, but that opportunity has been missed.

Stephen Ladyman: The definition of personal care is already very thoroughly covered in existing legislation, which is why it does not need to be in this legislation, and why the hon. Gentleman's criticism of the Chair for not choosing an amendment on that is rather unfair.

Greg Mulholland: That is the hon. Gentleman's opinion, and he is-

The Chairman: Order. The hon. Member for South Thanet (Dr. Ladyman) should not presume a degree of censoriousness on the part of the Chair, which the occupant of the Chair had not leapt to make clear. So I think the hon. Member for Leeds, North-West (Greg Mulholland) has got away with it.

Greg Mulholland: I thank you for that, Sir Alan. The hon. Member for South Thanet (Dr. Ladyman) is entitled to his opinion, but Help the Aged and Age Concern are equally entitled to theirs, and I know who I would listen to first and foremost when discussing policy of this nature.
	Turning to the two amendments of the hon. Member for Eddisbury (Mr. O'Brien), I share the concern that there is insufficient clarification of what is meant. The right hon. Member for Charnwood (Mr. Dorrell) has put his finger on the key point: what is crucial to consider is who is excluded by the Bill. It touches only a tiny number of the people who are affected by the problems of the social care crisis, which has been getting worse for many years.
	In terms of the amendments, however, I have some concerns about the definition offered. Concerns have rightly been expressed about what is meant by extra care housing, but we must also consider the meaning of "sheltered accommodation" and "warden controlled accommodation", which are mentioned in the list in amendment 9. What do we mean by "sheltered accommodation"? Is there an absolute definition of that? I suggest that there probably is not-there certainly is not from a legislative point of view. Is it not possible for someone to buy and own or, indeed, to rent what is clearly their own home in which they live but for it to be subject to some oversight from an organisation and thus fall under the category of "sheltered accommodation"? We are in danger of entering a minefield here, so we must be clear on this issue.
	As the hon. Member for Eddisbury made clear, this is a probing amendment, so I just ask the Minister to give the Committee clarity. He must show that the Bill and the Government are clear about what is meant by people who are "at home" and need to receive this accommodation. They must make it clear that there is no possibility, in respect of sheltered accommodation, extra care housing or warden controlled accommodation, of people who are clearly living in their own home-in a way that any normal person would recognise-falling outside the remit of this Bill.

Stephen Dorrell: I congratulate my hon. Friend the Member for Eddisbury (Mr. O'Brien) on his amendment, and not because I think that he is seriously suggesting that it should be included in the Bill-he has made it explicitly clear that that is not his intention. He intends to focus the Committee's attention on the large group of people who are defined out of, or excluded from, the category of beneficiaries of the Prime Minister's pledge; as I said in my intervention, these are the people who are excluded from benefiting from the pledge.
	Of course, across the House, we all acknowledge that this long-standing aspect of public policy has not been satisfactory. It was the former Prime Minister who, soon after the 1997 election, made it clear that payment for social care needed to be the subject of rigorous and profound examination. That is not the purpose of this amendment; it is an attempt to define clearly the large group of people who are excluded from benefiting from this Prime Minister's pledge, rather than focusing attention on the relatively small number who will benefit from it. The reason for focusing on the people who are excluded is to remind the Committee of the very much larger group of people who remain, as they have since 1997, suffering from a system of payment for social care that Members from across the House acknowledge to be inadequate.

Norman Lamb: The right hon. Gentleman is right to point out the large number of people who are excluded from this Bill, but this goes further than that, does it not? The imposition of the duty in respect of the small group of people who will be included within the terms of the provision could well adversely affect all those who are excluded, particularly those who are currently benefiting from care provided by local authorities on a discretionary basis-they could well see their care cut back.

Stephen Dorrell: The hon. Gentleman is entirely right, because of course the cost of even this limited pledge is significant in public expenditure terms and the Government have made it crystal clear that no additional money will be provided to local authorities to allow them to meet the additional burdens that this pledge imposes on them. Thus, it must be assumed that somebody, somewhere else, who benefits from local government expenditure-as he says, it is likely to be other people who benefit from social service expenditure-will pay for this pledge from the Prime Minister.
	As a result of the amendment tabled by my hon. Friend the Member for Eddisbury, I wish to focus on the implications of creating this distinction between the small group of people who will benefit because they receive "personal care at home" and the much larger group who will still have to pay for personal care under the old rules. What are the implications of creating that new distinction? I suggest that there are three such implications on which the Committee should focus.
	The first is the short-term implication. A group of people who change their care arrangements according to their requirements will suddenly find themselves taking decisions based on a major cost implication that ought to be taken based on their care need. There will be two categories: those who are at home, who get all their personal care free; and those who are defined as out of the "at home" category, who will still have to pay for their personal care according to the old rules. It therefore matters hugely who is "at home" and who is not "at home", and the amendment tabled by my hon. Friend the Member for Eddisbury is an attempt to define precisely who is not "at home".
	The former Minister, the hon. Member for South Thanet (Dr. Ladyman), reacted to my hon. Friend's amendment by saying, "Oh, these people who receive extra care ought to benefit from the pledge." Perhaps they ought to benefit from the pledge, but if they do, the cost will go up immeasurably from the £500-odd million that the Government say that it will already cost. My hon. Friend is drawing attention to the fact that the much larger group of people who do not receive personal care "at home" will be the losers from this prime ministerial election pledge.
	That is the first implication: where there is currently a logical development of care provision, in future there will be two categories and an anomaly created by the move from one category to the other. That is the first and immediate consequence. The second consequence, which is, in my view, much more malign, is that if this policy were to endure for any length of time, people would change their behaviour to ensure that they fell on the right side of the line to benefit from the pledge rather than on the wrong side of it.
	Let me pose a few questions to the Committee. If personal care at home is free, but personal care delivered not at home is not free, is somebody allowed to move their home in order to ensure that their personal arrangements move from one side of the line to the other? Members of this House have learned over the past 12 months the dangers of moving their house from one place to another in order to qualify under rules under which one did not previously qualify. If we create a group of people for whom personal care is free and say that it is available only to those who are at home, we should not be surprised if people who receive personal care and do not qualify immediately change their arrangements in order to ensure that they qualify. The definition of what constitutes "at home"-of who is included and who is excluded-will be the subject of constant challenge as people change their arrangements to ensure that they qualify, although they originally did not.
	I was reading the definition that the Government have offered of people who are excluded from the benefit of the pledge. Let me repeat it to the House. People are excluded if there is
	"the provision of personal care to a person living in accommodation that an establishment provides to the person together with the care".
	If I provide accommodation and personal care to my parents in my grannexe, will that be included or excluded? Is a grannexe where I or my family provide personal care to my elderly relative included or excluded? Is my grannexe an "establishment" according to the definition in this statute? It is unclear to me.

Robert Syms: My right hon. Friend makes a very important point. He also raises the issue of whether the provision of personal care by a relative is likely to be acceptable, as it is in the Netherlands and some other countries within Europe, or not.

Stephen Dorrell: Absolutely. If, as I profoundly hope given all the pressures on public expenditure, we are not going to get into the business of using taxpayer resources to pay relatives to give care, where will the dividing line be drawn, given that we are creating a very powerful incentive to people to change their behaviour?

Norman Lamb: The right hon. Gentleman makes a very good point about the danger of a partial solution changing behaviour and having perverse consequences, but does he not agree that the Conservative proposal carries the same risk in that the pledge relates only to providing for the cost, through insurance, of care in residential homes? That is also a partial solution that would influence people's decisions.

Stephen Dorrell: The difference is that my party is committed to moving quickly to the development of a total solution. We have made it clear, and it has been clear in our thinking right back to my days as the Secretary of State, that we cannot do that by landing the bill, in either small or large stages, on the taxpayer. The Government also took that view until the summer; indeed, until a day in October the Government took the view that this was an unaffordable bill for the taxpayer. That conclusion must underlie sensible policy in this area, but it is under challenge as a result of the Prime Minister's pledge.

Stephen O'Brien: May I take my right hon. Friend back to the difficulties that he rightly outlined about the definitional point and how things might change? Earlier, I gave an example about how an owner of accommodation might be able to change things by having two companies. I am reminded that on Second Reading the hon. Member for South Thanet (Dr. Ladyman) helpfully described as extra care accommodation a specific type of accommodation in which people might buy into a retirement village and be able to move around within it as tenants and leaseholders. It is precisely because such arrangements can be changed both by the owners and, as has been pointed out, by the tenants that we are having to raise these doubts through this probing amendment.

Stephen Dorrell: I am grateful to my hon. Friend for his comments, and I agree with him. What is clearly illustrated here is that any attempt to write into the statute book crude rules that create one category of free personal care and another of paid personal care will be fraught with difficulty, particularly when one is trying to do it at 20 minutes' notice, on the run, on the way to the podium at the Labour party conference. I agree with Lord Lipsey that that is one way not to make policy.
	I have a final question to put to the Minister.

Stephen Ladyman: Will the right hon. Gentleman give way?

Stephen Dorrell: I shall look forward to putting my question to the Minister, but I shall give way one more time.

Stephen Ladyman: The right hon. Gentleman is making some important points, but will he reconsider his statement that this is a crude way of achieving the objective? The measure simply removes the six-week limitation on free care from another piece of legislation that has been operating very successfully for some years. It is therefore anything but crude. The precedents and definitions have all been set, and all that the clause does is say that instead of the free care being limited to six weeks, it can be provided for much longer.

Stephen Dorrell: With respect, I think that the hon. Gentleman is being disingenuous. My recollection is that the six-week limitation was introduced specifically to prevent policy from migrating in this direction, while still allowing the discharge of patients from hospital when they should no longer be in there. It was introduced to facilitate orderly discharge out of the NHS, rather than as precursor to the development of free personal care in the social care sector.

Stephen Ladyman: I certainly was not trying to be disingenuous. The legislation that is being amended says that the Government can tell local authorities in certain circumstances to provide people's care for free in their own home for a period of six weeks. The measure simply takes the six-week limit away. The rules and precedents that define the system are already established, so this is actually quite a neat and elegant way of achieving the aim quickly.

Stephen Dorrell: I genuinely listen to what the hon. Gentleman has to say, and I recognise that he has knowledge in this area, but I think that he is wrong on this point. He says that the measure simply removes a bureaucratic rule, but doing so changes the nature of the rule on free personal care at home. The six-week rule was designed to facilitate the discharge of patients at the end of their NHS care in NHS hospitals. It was not designed as a means of funding social care for anything other than the shortest terms in that context.
	I have spoken about people changing their behaviour and so forth, but they will not do that in anything other than the most convenient way to ensure that they qualify for the six-week limit. Social care can go on for years, or even decades in some cases, so all the points that I have made about changing behaviour and the pattern of provision apply in a way that they do not in the context of the six-week rule.
	My final question to the Minister is very important. Under the direct payments legislation, individual beneficiaries of social care can convert their entitlement to social care into a direct payment, but will that apply to personal care provided in the context of this pledge? If so, that is another extremely powerful incentive for people to change their behaviour in order to qualify under the rules.

Phil Hope: Of course it will.

Stephen Dorrell: The Minister says that of course it will, but I challenge the Government on that. If the direct payments legislation does apply to care provided on this basis, I simply do not believe that, beyond the first few months, the cost of the scheme could be limited to anywhere near the £530-odd million that the Government have estimated for the scheme as a whole.

Robert Syms: I am generally in favour of one-clause Bills, and most of us have sat in Committees considering Bills of 200 or 300 clauses. Nevertheless, such a short Bill means that trying to find out its implications presents a problem, and that Opposition Front-Bench Members must show ingenuity in engendering a debate that allows information to be put on the record. That information is needed so that the people who provide and receive the care can learn a little more.
	I agree with my right hon. Friend the Member for Charnwood (Mr. Dorrell). I listened to what the hon. Member for South Thanet (Dr. Ladyman) said, and he has participated in this debate for a long time, but the change in the six-week rule does make quite substantial differences to the overall pattern of care.
	If Opposition Members are cynical about the proposal that may be because one of the first things that the Government did after 1997 was to set up a royal commission that recommended free personal care, but that got dropped. Now here we are at the fag end of a Parliament and we get this rushed Bill, with questionable costings, which will fall after the election, and big implications for many of our constituents. Although amendments 9 and 10 may not be perfect, they at least allow us the opportunity to raise important questions.
	The Government themselves produced the Green Paper, and I thought that it was a good effort at looking at the whole system comprehensively. The Select Committee on Health is looking at personal care, so it is a pity that we are rushing ahead with this option without taking a comprehensive look at things. When one rushes ahead one creates cliff edges and biases in a system that benefit some and exclude others. As I think the hon. Gentleman said, the implication is that, subject to the funding arrangements, we will have to add another bit to the Bill to make it more comprehensive in the future. Definitions are very important, and I am still not sure that we have got to the bottom of that argument.
	Costings are also very important, and the Government are using the "magic pot of gold" argument that I have heard time and time again. The efficiency savings that they propose will be made at the expense of local government, which is going to have a difficult time over the next few years. Amendments 9 and 10 give us the opportunity to say a few words about that.
	When the Minister responds, I hope that he can answer some of the very important questions that have been raised and give some reassurance that the Government have thought through the Bill's implications rather more comprehensively than seems to be the case at first glance. However, I fear that perverse incentives are now going to be built into the system. If local authorities have to provide more money but do not have the budget to do so, my concern is that they will deal with the changes by spreading what they have rather more thinly. That could mean that although 380,000 people will benefit from the legislation, if the funding is not sufficiently robust, they will not benefit to the extent expected.

Norman Lamb: May I pursue briefly the point raised by the right hon. Member for Charnwood (Mr. Dorrell) with regard to direct payments? The Minister, from a sedentary position, said that of course the Bill provided for the support to be given by way of a direct payment, but when we sought to table an amendment to clarify that, we were told that it was outside the money resolution, and that that was not what the Bill provided for, because it provided for care at home.
	If that is the case, the Bill will pursue policy in a very different direction from that which the Government have followed up till now, and the outcome will be the perverse situation that someone receiving care under means-tested arrangements will be encouraged to receive their care by way of a direct payment, giving them maximum flexibility in how they chose to spend that money, whereas someone receiving care as an entitlement by virtue of the Bill will be entitled only to receive care imposed on them, in a sense, by the local authority.
	It is self-evidently important for the Minister to clarify whether the Bill provides for the provision of support by way of a direct payment. If it does not, it is clear that an amendment needs to be tabled by the Government if it is beyond the scope of Opposition parties to do so.

Lee Scott: May I emphasise, as other hon. Members have done, that it is vital that whatever pressures are put on local government, it is given the full funding by central Government to pay for the measures, and that that funding is not expected to come from existing budgets, or it will not be viable and will not happen?

Phil Hope: I am pleased to be taking the Bill through its Committee stage on the Floor of the House. In addressing the amendments, I should like to place my remarks in a slightly wider context.
	The hon. Member for Leeds, North-West (Greg Mulholland) said that the Bill was very small, but I can tell him that it will have a very big impact. As the Minister of State with responsibility for care services, I am hugely proud to take the Bill through its Committee stage and Third Reading this evening. The Bill will provide support and relief to some 400,000 older people with the greatest personal care needs in their own home-people with advancing conditions such as Parkinson's, dementia and motor neurone disease-and 280,000 people who require high levels of intimate personal care on a day-to-day basis at home will now get those services free.
	As has been remarked, many of those people have faced the burden of paying large amounts of their own money-they do not lose their own homes; my hon. Friend the Member for South Thanet (Dr. Ladyman) rightly corrected the hon. Member for Eddisbury (Mr. O'Brien) on that-for care as their conditions deteriorate. The Bill will remove that millstone.

Norman Lamb: Is it not the case, though, that a significant proportion of those people whom the Minister identifies as benefiting already benefit by way of the means-tested system, that the net number will be significantly smaller than the number that he cites, and that, as the Government's own impact analysis demonstrates, the wealthiest group of pensioners will benefit most?

Phil Hope: I do not want to stray from the amendments, but the hon. Gentleman is right to say that a number of people who will benefit for the first time are self-funders, and a number of people who pass the means test and qualify for free personal care will have that free personal care safeguarded as a result of the Bill. That is particularly important, given the uncertainties of the future.

Simon Burns: rose-

Phil Hope: I am happy to give way, but I should like to start to address the amendments.

Simon Burns: I am grateful to the Minister for giving way. On a point of information, if the Bill were to become law and came into effect on 6 April, would people who are currently self-funding their care qualify, or would only new patients with medical conditions developing who required help be covered by the Act, as it would then be?

Phil Hope: First, it is social care, not medical care, that is being provided. The hon. Gentleman's phraseology suggested that he was talking about medical care, and I want to make it clear that this is about personal care for people whose need is most critical and who need help with toileting, and so on. This is about intimate personal care.
	A number of guidelines and regulations are out for consultation, and they will need to be enacted when the Bill receives Royal Assent. People will qualify from 1 October this year. The process by which that will happen will also be the subject of guidance, to ensure a smooth transition as people who are currently in their own home and who qualify under the appropriate criteria start to qualify for free personal care. The provisions apply not only to new entrants; people who are currently living in their own home and paying for personal care because they failed the means test will now start to get their care for free. A further 130,000 will receive free reablement or rehabilitation to help them to recover their independence after a fall, a bereavement or a serious illness. I will say more about that when we discuss the later amendments.
	The Bill is based on the simple principle that we must do everything that we can to help people to live as well as they can and for as long as they can in their own home. That is what people tell us they want. This Government policy has been shared by both parties, at least since 1998 when the Griffiths report was produced. Indeed, the right hon. Member for Charnwood (Mr. Dorrell), when he was Secretary of State, supported the view that we should give as much support as possible to people in their own home, because that is what they want. I have listened to his remarks and those of his Front-Bench colleagues today, and I hope that that position has not changed. I hope that all parties in the House will support and respect the wishes of people-young adults as well as older people-to live in their own home.
	Amendment 9 would amend section 15(4)(b) of the Community Care (Delayed Discharges etc.) Act 2003 so as specifically to list a number of settings in relation to which a six-week restriction on the ability of regulations to require provision of personal care for free would remain. The hon. Member for Eddisbury described it as a probing amendment, and I understand that, although I think that Labour Members listened quite carefully to ensure that that was the case and that the Conservatives' position had not changed.
	The list in amendment 9 is entirely inappropriate, as it includes some settings that are more appropriately described in the way that clause 1(2) describes them, and some settings that we would describe as falling within the notion of living at home-such as extra care housing, sheltered accommodation and warden-controlled accommodation, all of which are listed in the amendment.
	My hon. Friend the Member for South Thanet spoke from his experience as a Minister in this Department, and from his own professional experience, when he described the importance of extra care housing. I very much share his view. I listened carefully to the concern expressed by the hon. Gentleman that there might be game-playing among care home owners trying to change the status of their homes- [ Interruption. ] That was indeed mentioned on Second Reading; if I said this on Second Reading, I am certainly happy to put it on the record again.
	It is for the Care Quality Commission to register care homes and extra care housing. Only care homes that genuinely change the nature of the care they provide to create extra care housing would be registered as such. As my hon. Friend said, we do not need to write all that into the Bill, because we have a regulator to ensure that the kind of behaviour described by the hon. Gentleman would not happen. The right hon. Member for Charnwood gave the example of granny annexes. People living in such accommodation would also qualify for free personal care because they are not in residential care accommodation.
	The Bill does not list all types of accommodation. Its provisions are straightforward. Apart from the one circumstance of adult placements-we will discuss an amendment on that later-we have excluded anybody in a residential care home from qualifying for free personal care. Everybody else is included by default because they are not excluded. That is how the Bill is designed. It is an elegant way-my hon. Friend described it as such-of achieving the policy goal that we want to achieve, which is to provide for and help people with the greatest possible needs who are living in their own homes.
	The right hon. Gentleman suggested that we have identified one group but ignored everybody else. The problem with his approach is that it would be a case of saying that we should either do everything or do nothing-that we should not introduce this extremely important measure to help people in the most need in their own homes. Why did we introduce a carers strategy? Why did we introduce a dementia strategy? Why did we introduce a strategy on valuing people with learning difficulties? We did those things because we are building on, improving and raising the quality of care step by step.
	The hon. Member for Poole (Mr. Syms) indicated, as he did on Second Reading, that he favours the Green Paper. I am delighted that I have a convert from the Conservative party. Indeed, many of his colleagues praised quite lavishly the Green Paper, which is being considered with a view to transforming the whole system. I am proud to be the Minister of State standing at this Dispatch Box leading on the proposal to create a national care service-how good can it get?-but that does not mean that I am going to stand still while I am waiting for that to happen; I want change now, as well. Step by step, the building blocks towards creating a national care service are being put in place, and this measure is a key part of that.
	Amendment 10, as an alternative to the approach that we are taking, would insert a definition of "care home" into the Bill. We regard that as unnecessary. The description that the Bill uses in amending section 15(4)(b) of the Community Care (Delayed Discharges etc.) Act 2003 is
	"accommodation that an establishment provides to the person together with the care".
	We do not propose to change that. The hon. Member for Eddisbury proposes in his probing amendment that we should use the definition in the Care Standards Act 2000, but that is not right in this context because it includes some exemptions and exceptions and therefore would not accurately reflect the range of settings that we want to exclude from free personal care. We think that our approach is the right way forward.
	In response to the hon. Member for North Norfolk (Norman Lamb), yes, direct payments would be a method of providing such free personal care if someone chose to go down that road. This is an important point about the very nature of the transformation of the care system. Increasingly, we want people to have more choice and more control over their care budgets, and direct payments are one way of doing that. Personal budgets, which are a development of that approach, are being rolled out across the country, with more than 100,000 individuals now receiving their care in that way, giving them choice and control. This is free care for the people in the most need. If they choose to have it through a direct payment or as a personal budget, that is absolutely the right thing to do. It will be up to local authorities to develop and implement this approach-that is what our extra £500 million for the transforming social care budget is all about. Some authorities are getting there quicker than others. I hope that the measure will provide an incentive for some of those authorities to start to develop their services in a way that we, and I hope the whole House, would like them to offer in taking forward their care provision.

Norman Lamb: I am grateful to the Minister for clarifying that narrow point. However, should there not be an entitlement for the person to receive the help by way of a direct payment instead of leaving it up to the local authority to decide?

Phil Hope: We will discuss issues to do with local authority discretion under subsequent amendments, so I will deal with that question then.
	I think that I have answered all hon. Members' questions. I have explained why the Bill is framed as it is and why amendments 9 and 10 are inappropriate and unnecessary. I therefore ask the hon. Member for Eddisbury to withdraw the amendment.

Stephen O'Brien: The debate has been extremely helpful and constructive in bringing out precisely what the amendments were intended to probe and elucidate. It has been acknowledged that where the dividing line falls is an issue to consider, and that we need greater clarification. It is possible that as the Bill progresses through its next stages in the other place, their lordships may wish to take up some of our questions to get that clarification, but we have had a good exploration of the matter.
	As I said, these are probing amendments. I am glad that the hon. Member for South Thanet (Dr. Ladyman) felt reassured by the way in which I dealt with his concerns about whether there is mutual understanding on extra care communities and the home settings to which they relate. However, at one point he asserted that there was a principle that people do not get free board and lodging, as though that were somehow not to be challenged. That is not true either in a hospital setting or in many other settings. We need to be careful about announcing principles as though they were inviolate, when I am not sure that they stand a true examination.
	As was reflected in the comments of my right hon. Friend the Member for Charnwood (Mr. Dorrell) and others, it is important to recognise that despite some of the discussion that has taken place, we must not look at the matter as though it were simply about removing a six-week time limit and not changing any other circumstances. The hon. Gentleman gave the game away when he talked about certain circumstances, because circumstances have changed. The 2003 Act, which the Bill is intended to amend, addressed a different mischief that needed remedying-inappropriate bed blocking in hospital settings. This Bill is not about that; it is about doing something to support people in their own homes. It is not about removing people from one setting but about what they get in another, so the circumstances have changed. It was helpful that the Minister made that clear, but the way in which the matter was discussed at other times was not particularly appropriate. We need to be very careful, because the clause does not provide for some kind of simple removal of an element of a Venn diagram. It is definitional, because it deals with who can qualify. We even heard the Minister try to explain the understandably complicated matter of how on 1 October, if the Bill receives Royal Assent, the system will include both people who currently receive some care support, who may have to pay for it or may get it free, and others with different transitional arrangements. Later amendments will cover that matter.
	This discussion has helped set us off towards a greater understanding of the complications of how the Bill is drafted and the concept that lies behind it. More importantly, it has helped to ensure that we get as much clarity on the record as we possibly can. I beg to ask leave to withdraw the amendment.
	 Amendment, by leave, withdrawn.

Stephen O'Brien: I beg to move amendment 11, page 1, line 10, after 'apply', insert-
	'(a) '.

The Chairman: With this it will be convenient to discuss amendment 12, page 1, line 13, at end insert-
	'(b) to such other arrangements for the provision of personal care as the Secretary of State may, by regulations, specify.'.

Stephen O'Brien: Amendments 11 and 12 are intended to allow secondary legislation to stop the six-week restriction on free personal care. Amendment 12 is the operative amendment, upon which the Committee may wish to express its opinion depending on what the Government say. I flag up the fact that although it is not the lead amendment, it will be the appropriate one on which to divide if there is to be a Division.
	It is somewhat disingenuous of the Minister to suggest that the provision in question is the direction of travel of the Green Paper. It is in fact a fully taxpayer-funded option, which was previously rejected by the Government in explicit terms, not least by the Secretary of State and the present Minister, because the working population of this country is shrinking as a proportion of the total population. That has been discussed and is widely recognised both in this place and by many experts and advisers outside. I refer the Minister to the Secretary of State's reply when he was keenly questioned by Members of his own party below the Gangway. He resisted their calls for taxpayer-funded options for social care, saying that it would not be
	"fair across the generations to ask the working age population to pay"
	for care. He continued by saying that
	"it would not be honest or straightforward to give the impression that we can fully fund a care system entirely from general taxation."-[ Official Report, 29 October 2009; Vol. 498, c. 479-81.]
	We agree, and that is part of the challenge in the Green Paper that we are all considering. However, this Bill proposes, for the class of people outlined in it, to provide an option for care fully funded by taxation. That is inconsonant, to put it one way, with the direction of the travel in the Green Paper, although some might call it disingenuous.
	The Minister confessed, in a parliamentary answer:
	"It is very important not to conflate the funding for a national care service with the funding for the Government's Personal Care at Home Bill. The Green Paper"-
	unlike this Bill-
	"is about building a sustainable system for the future".-[ Official Report, 5 January 2010; Vol. 503, c. 277W.]
	We all agree with that, but does it mean that the Minister is suggesting that this Bill is not sustainable for the future? Does he in fact agree with the point made by my right hon. Friend the Member for Charnwood (Mr. Dorrell) in the debate on the previous group of amendments that the Bill is a step along a path that may be distinguishable in legal terms, but will certainly be superseded in policy and legislative terms. That is a genuine question, and it is why we have included enabling powers in amendment 12.
	The Minister has also said in a parliamentary answer that the measure in the Bill
	"was not considered in the Green Paper"-
	that is a confession-
	"because it is a step towards that National Care Service. The Green Paper puts forward fundamental proposals".-[ Official Report, 9 December 2009; Vol. 502, c. 497W.]
	If this is not a fundamental proposal, does that mean that the Government plan it only as an interim measure?
	The best way for the Government to make earnest on their pledge that this Bill is a step towards the full reform of social care would be to make this Bill more enabling in terms of additional policy options. One of those could be our asset protection scheme, which would involve the option of paying £8,000 at age 65 by those who have sufficient assets. Those who do not have such assets would continue to be protected, and those who did not take up the option would be in no worse position than they are today. Those who did take up the option would be entitled to residential care for life, should it be necessary. Who is to say that similar schemes could not work alongside the Government's measure in domiciliary care? We are not precious about the scheme, and it would provide an opportunity to widen the Bill and bring in a much more comprehensive approach that would genuinely be consonant with the Green Paper, which was welcomed-and urged on the Government-by both sides of the House.

Robert Syms: My hon. Friend makes an important point, but one of the problems with providing free personal care is that it tends to undermine the argument for a private insurance option, which may have to be one of a range of options if we are to look after people in old age.

Stephen O'Brien: My hon. Friend makes an important observation. I do not wish to underestimate the importance of this issue. We all accept that we face a serious challenge on this issue, and the question is how we measure up as policy makers and legislators. The issues include access, fairness, quality and appropriateness of care, both in the home and in a residential setting. It also involves major social issues such as the intergenerational responsibilities that we all have as members of the working age population for those who are beyond earning age or who have never had the capacity to earn or look after themselves because of some form of difficulty or care need.
	My hon. Friend is entirely right to set the Bill in the context of the Green Paper process. We are challenging the fact that it does not sit well with that process, which the Government have already defined. Whether or not we end up with the social insurance model for all aspects of care need-he mentioned that, but I note he did not necessarily advocate it-is part of the discussion and the consultation. I fully accept that the Government have been conducting a consultation and I look forward to their assessment, which will inform us of the context of today's discussion, including on amendments 11 and 12.
	We feel strongly that amendment 12-the operative amendment-gives an opportunity to air the questions that my hon. Friend asks in the context of the Green Paper process, which is vital. As the Government know, that process has been widely welcomed, even if it has come late and been postponed. It follows a series of other Green Papers and consultations, but is none the less a step in the right direction. The concern is that the Bill does not feel as if it is consonant with the process.

Stephen Ladyman: I support the idea behind the hon. Gentleman's statement that what we ultimately need is a comprehensive model for providing social care, and I have made it clear in my remarks on the Bill that more finance from people themselves is going to be necessary if we are to have that. However, will he confirm whether amendment 12 is a probing amendment? My understanding is that the proposal would give the Secretary of State power to introduce such new arrangements by diktat, without ever having to come back to the House for a proper debate or to discuss a new Bill in future. That seems to me to be an awful lot of power over an awful lot of expenditure to put in the hands of a Secretary of State, even one who is as good as our current Secretary of State.

Stephen O'Brien: Aside from the enjoyable little tail to that question, which I am absolutely sure deserves a job, I have not confirmed whether amendment 12 is a probing amendment, because I genuinely wanted to test the opinion of the Committee. I am not suggesting that I will therefore press it to a Division; rather, I am seeking to test whether there is an opinion in the Committee that the way the Bill has been introduced fits well with the overall direction of travel. I dare say that there could have been a touch of irony in a debate on amendment 12-if  Hansard can record irony-because it might have revealed whether the hon. Gentleman was confident that a Labour Secretary of State would be exercising the powers, or whether he thought there would be a Conservative Secretary of State. However, I would not presume to take such powers on behalf of my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) if the electorate decided that he should be Secretary of State.
	The amendment seeks to test whether the Committee thinks it appropriate that we should be discussing the matter in a wider context. The hon. Member for Leeds, North-West (Greg Mulholland), who speaks for the Liberal Democrats, twice mentioned that the extreme tightness of the drafting in the money resolution, which is deliberate on the part of the Government-but that is how it is-has clearly made the selection of the amendments particularly tight and challenging. Amendment 12 has given us the opportunity to at least have a sense of getting that discussion moving. We will decide whether the Committee needs to give it a better airing once we have had our discussion.

Norman Lamb: To pursue the point raised by the hon. Member for South Thanet (Dr. Ladyman), does the hon. Member for Eddisbury (Mr. O'Brien) accept that amendment 12 could allow the Secretary of State, whichever party wins the election, to implement wide-ranging reform, without this House having any opportunity to debate it properly? Does he accept that that would be inappropriate, and that there should be primary legislation in the new Parliament to implement fundamental reform?

Stephen O'Brien: The hon. Gentleman fully accepts, I think, that although the Secretary of State, in his current role, has made it clear that, as part of a legacy, or whatever he wishes to claim for it, he seeks an unstoppable momentum beyond the next election, our concern is that, strangely enough, the Bill is in danger of not creating that momentum. Indeed, it could do the opposite, because it is not consonant with the whole approach to the reform of social care that we hope the Green Paper process, which so many of us have bought into, will achieve.
	I fully accept that, ultimately, there is only one way forward, which is for the country, through its elected representatives across the House, to seek a genuinely broad consensus. We will never satisfy either those who think there should be a fully taxpayer-funded option or those who think we should have a complete free-for-all in the private market. The solution lies somewhere between the two. We have had that discussion with Government Members. We know that a number of them would not go along with what has been proposed, so reaching that point will be a tough challenge. That is why amendment 11 is important in clarifying the intent. However, I will wait to see how the Committee feels about the issue before I make a decision on whether to press the amendment to a vote, because I take seriously the idea that we need the best and most solid consensus that we can achieve.
	One thing that I should say-I see that the Minister is in discussion at the moment-is that it would be helpful in building that consensus if there were a genuine willingness on the part of the Government to start some discussions and to invite in those of us who wish to build that consensus. However, while we remain only in discussion across the Dispatch Box, which is necessarily a somewhat scrutinising and adversarial approach, we diminish our chance of achieving consensus. However, that is perhaps the nature of the run-up to the election, with the tribalism now being displayed.

Robert Syms: I would like to bring my hon. Friend back to amendment 12, which is excellent. I thought that its drafting was intended to engender a debate not about what the Government are doing in the Bill, but about what they are doing in guidance and consultation. We do not know whether there will be statutory instruments or whether they will use the positive or negative procedure. A lot of the detail will be discussed in consultation and decided after the Bill has been passed. We will therefore not know the shape of the Bill until we see what comes forward. Is that not one of the arguments against rushing the Bill? Should we not have the consultation and then the Bill, rather than the Bill and then the consultation?

Stephen O'Brien: My hon. Friend makes an outstandingly good point, and that is precisely why we have been so concerned about the rushed nature of the Bill. We know its provenance: we know how its timing came about and how it must have been a hell of a sweat, in a certain room at a certain hotel, in a certain month-September-with a certain Prime Minister. That said, we should pause and ensure that we do not lose the many gains that we have made in this debate over many years, as my right hon. Friend the Member for Charnwood has observed. It is vital that we should see the Bill in that context.
	The whole point of amendment 12 is precisely as my hon. Friend the Member for Poole (Mr. Syms) described. It is not just the whole context of the Green Paper that is important; there will, of course, be a vital need for guidelines. Indeed, in his response to the first group of amendments, the Minister talked about the need for guidelines and so forth. However, the timetable for those guidelines seems to be out of sync. It is my great hope-I will no doubt repeat this later in our proceedings this afternoon-that the Government will take seriously the point that there is a certain technical obligation on them, as well as a moral obligation, to ensure that they get the consultation and guidelines processed, reported and acted upon, with conclusions recommended as a result of that broad, wide-reaching and consensual consultation, before the issue is considered in the other place. Without that, there is a grave danger that the Bill will be rushed through both Houses without the benefit of accessing that broader church of opinion, which Government Members have been as keen as I have to ensure is accessed.

Laura Moffatt: I am listening carefully to the hon. Gentleman, but is he not trying to have it both ways? I would love to move directly to a national care service, as I hope many who have taken an interest in the Bill would too. However, I respect and understand the need for us to think carefully about the financial implications. Is he not giving the impression, particularly with amendment 12, of an open book for what could be achieved? By tabling that amendment, is he not giving the impression that something more could be delivered, when he knows that we are all under serious financial constraints?

Stephen O'Brien: I do not think for a second that anyone in the House seeking to develop or implement policy responsibly or anyone who has any kind of sense of the reality of the world in which we live would suggest that anything should be proposed on behalf of our constituents without full funding behind it. That is why leaving it totally to the discretion of the Secretary of State would be entirely out of order. It is drafted in the way it is because the Secretary of State would not be expected to propose anything without coming along not only with an impact assessment-hopefully a considerably better quality one than we have suffered from with this Bill-but with a funding base to justify it.
	To the extent that the hon. Member for Crawley (Laura Moffatt) is suggesting a carte blanche, I do not believe that any legislation could come along on that basis. It is appropriate to ensure in Committee that we can have the wider contextual debate that we all seek. I know from previous discussions that the hon. Lady has been keen to see such a debate on the Green Paper, but we are concerned about the limitations of the very process that the Bill is imposing on us.

Tom Clarke: The hon. Gentleman has been extremely generous in giving way. His point in response to my hon. Friend the Member for Crawley (Laura Moffatt) is one of the most critical to bear in mind this afternoon as we Government Members probe amendments tabled by Opposition Members. The question of funding is particularly important, so has the hon. Gentleman consulted the shadow Chancellor and his senior Front-Bench colleagues? If so, will he tell us about the funding implications and who will bear the cost?

Stephen O'Brien: I am grateful to the right hon. Gentleman, partly because what he suggests is relatively flattering. Luckily, however, I am enough of a realist to recognise that, nice as it may feel, it is not the same as being in government when the Opposition's probing or other amendments are probed in turn by Government Members. I can assure the right hon. Gentleman that there have, of course, been extensive internal discussions, as he would expect, within my party-as I dare say there have been within his party-on how to grapple with this particular issue.
	Those in charge of funding must be included. Why? Because, as I said before, there is probably no more predictable issue for the political generation coming down the track than this one. We know it is there; we all know it is pretty insuperable, but we have got to find a solution. None are more challenged than this generation of politicians in this House-either this side of the general election or after it when some may be re-elected-in facing up to this particular challenge. The right hon. Gentleman is rightly probing me on why I tabled certain amendments, but I am very conscious that we have had a series of discussions and open inquiries, not least the one led by my right hon. Friend the Member for Charnwood shortly after my right hon. Friend the Member for Witney (Mr. Cameron) became the leader of the Conservative party. They looked into these very issues, so my right hon. Friend the Member for Charnwood has been able to advise us accordingly. That has led, in turn, to many discussions among and across many shadow departmental briefs.
	I hope that that gives the right hon. Gentleman the reassurance that he sought-that this matter is being taken extremely seriously, as the issue betokens. If our generation ducks this one, we will be in grave danger. My plea to the Minister is, as I have said repeatedly from the Front Bench, that there could be a way to gain a better and more consensual approach, given that we are all in this together. At the moment, this has fallen somewhat flat, as the Minister has not formally invited me or Liberal Democrat Front-Bench Members to have a consensual chat about these matters. I would be very happy to participate in that, even if it were completely off the record, not least because there is a precedent-this relates partly to the amendment-for something along these lines in respect of pensions. There has been a greater degree of consensus on how to find a way forward on that subject, which was also a challenge for us and will be for those coming down the track. It is important to place that on the record in the light of the quite proper rejoinder of the right hon. Member for Coatbridge, Chryston and Bellshill (Mr. Clarke), who wanted to probe my amendment; whether or not it is a probing amendment has yet to be decided.
	It is important to bear in mind the fact that the Bill amends the Community Care (Delayed Discharges etc.) Act 2003, whose purpose was to deal with what could have been described in legal terms as the mischief of bed blocking. Section 15 removed the limit at which care could be provided free of charge. I assume, although it may not be the case, that even if someone joined the social insurance risk pool mentioned by my hon. Friend the Member for Poole-the Government's Green Paper partnership option, for instance, is still very much under consideration-that would not count as a charge, in which case the Bill could make such a model possible. Given that Tony Blair promised reform 12 years ago, would it not be best for us to produce a consensus to make full reform of social care possible through the Bill? The amendment was intended to give us a genuine opportunity to consider that question.

Several hon. Members: rose -

The Chairman: Order. Before I call the next speaker, let me point out that although there are clearly serious matters at the heart of this debate, I have allowed some tolerance of the wider conceptual debate. However, I am not sure that we would be best served by the inclusion of a wider conceptual debate on every group of amendments, and I shall be paying attention in that regard.

Stephen Ladyman: I think there is some common ground between the hon. Member for Eddisbury (Mr. O'Brien) and me. I agree that this measure must, at some point in the future, be swept into a more comprehensive and consensual package. I also believe that that comprehensive package must include some sort of asset protection scheme for those who go into residential accommodation, although I do not favour the scheme suggested by the Conservatives.
	The hon. Gentleman said that the Bill had been dreamt up by the Prime Minister at short notice and cleared in time for a conference speech. I do not know whether that is true, but I do know that the Conservatives' response in the shape of their proposed asset protection plan was dreamt up in the seven days following the Prime Minister's speech, in time for their own party conference.

Stephen O'Brien: I am happy to put on record that some of us had been working on the scheme for about three years. We were very glad to note that there just happened to be decent timing for its announcement.

Stephen Ladyman: I believe the hon. Gentleman; millions wouldn't.
	As I have said, there is some common ground between us. I agree that we need to sweep this measure into a more comprehensive package. However, the hon. Gentleman's proposed way of doing that is completely irresponsible. It is not just that the Secretary of State would be given power to introduce a complete social care system by diktat. If the hon. Gentleman looks at the 2003 Act, he will see that regulations which, by implication, he would allow the Secretary of State to draw up would not even be subject to an affirmative vote in Committee. They would be subject to a negative prayer. So not only would the Secretary of State be able to introduce a system costing tens of billions of pounds every year without debate on the Floor of the House; he might not even have to take part in a debate in Committee if the Opposition did not spot his proposal and pray against it.
	I assume that the hon. Gentleman had a gleam in his eye when he said that he did not know whether amendment 12 was a probing amendment, and that he is, in fact, probing. I hope that my hon. Friend the Minister will respond by saying that he agrees with me that this package should ultimately be part of a much more comprehensive reform.

Greg Mulholland: I do not think that anyone could disagree with what has been said by the hon. Member for South Thanet (Dr. Ladyman) and, indeed, the hon. Member for Eddisbury (Mr. O'Brien) about the need for a consensus. All along, much of the concern about the Bill has been that it is a partial solution which will help only a small number of people. We can, however, disagree on whether that would be a good step forward or unhelpful. There are different views on that.
	On amendment 12, however, I too listened to the hon. Member for Eddisbury, and I do not think that any of us could have disagreed with the vast majority of the sentiments that he expressed, in his usual eloquent, if rather lengthy, way. Nevertheless, we should consider his speech in the context of the amendment. It reads:
	"to such other arrangements for the provision of personal care as the Secretary of State may, by regulations, specify."
	I cannot see how that relates to the sentiments in his speech.
	The concern of Liberal Democrat Members is that the Bill is a partial solution and not part of the existing consensus. The Bill came in the middle of the consultation on the Green Paper, and I even wonder whether those involved in the consultation and in drafting the Green Paper had any idea that a Bill was coming when it was announced out of the blue by the Prime Minister. The Bill came in through the side door, but the hon. Gentleman's amendment would give the Secretary of State the opportunity to bring in anything via the back door. That would be even more regrettable and take us further away from achieving a cross-party consensus, which is precisely what we need if we are serious about moving the debate forward. If the hon. Gentleman presses amendment 12 to a vote, therefore, we will not support it.

Stephen Dorrell: I congratulate my hon. Friend the Member for Eddisbury (Mr. O'Brien) on being the first Minister of the next Conservative Government to propose a Henry VIII clause, seeking powers to create law by order on a wide range of subjects. He will, of course, be the first of many. Indeed, I suspect that he will propose many other such order-making powers in the months and years ahead. I have no doubt that the hon. Member for South Thanet (Dr. Ladyman), like me, has proposed similar order-making powers in the past. Were he to read in detail some of the statutes that he has recommended to the House, he would see that they contain such powers.
	Oppositions normally resist Henry VIII powers, rather than propose them, so I inquire of myself why my hon. Friend should have proposed such a wide-ranging order-making power. I have to say that I can see why he has done it. As the hon. Members for South Thanet and for Leeds, North-West (Greg Mulholland) recognised, my hon. Friend is in some sense responding to the challenge offered by the Minister, who, in response to the previous set of amendments, stressed that the Government consider the personal care at home policy an incremental change in the evolution of policy on social care delivery. That is, I think, the best gloss that can be put on the policy, and I congratulate the Minister on doing it.
	As became clear during discussion of earlier amendments and debates on the Bill, however, in reality the policy will, if executed, create in the short term a series of clear anomalies. My hon. Friend is therefore seeking a power on behalf of the Secretary of State to create a safety valve allowing precisely the kind of incremental development of policy that the Minister said was the Government's intention. It is important to be clear why my hon. Friend's proposed safety valve will be so important so quickly, and to understand that we must recognise that we are dealing with a set of services for which demand is growing rapidly.
	Ironically, the Government are creating a set of unintended consequences. They are saying that those living at home will receive tax-funded care, whereas those living in residential care will continue to rely on co-payment provision. I simply invite the Committee to consider which of those two funding packages is most likely to be able to respond to the very fast growing demand for these services in the years ahead. Is it the delivery of care at home, which relies on the ability of the Exchequer to pay for it, or the delivery of care in a residential context, which relies on a co-payment formula, requiring the care user to make a contribution?

Tom Clarke: I am listening very carefully to the debate, and my mind keeps going back to any number of discussions we have had in the past on community care, such as about the Griffiths report. A consensus developed then, part of which was that many people would be encouraged to live independently in their own homes while being properly supported through proper funding. When, therefore, has the change come in? I ask that because community care has not been mentioned at all this afternoon. Are we going back on that position, or do we accept that many people will reserve the right to live in their homes and should be given support to do so?

Stephen Dorrell: Like the right hon. Gentleman, I have a long memory on these subjects, and I agree with him that the debate on community care was motivated in large measure by a desire to provide-as the Minister rightly said-a proper package of care to encourage and enable people to live at home in the community rather than in residential contexts. That is what I was referring to when I said that the House should recognise that the statutory formula that the Government are now recommending to the House has a very sharp unintended consequence. We all agree that supporting people to live at home is what we want; everyone agrees that that is the better way of delivering care, and the right direction of travel, but it is that care package that is being cash-limited.

Phil Hope: The right hon. Gentleman says that everybody agrees that providing free personal care for people in their own home so that they can live independently is the right direction of travel. Why then does his party's Front-Bench team propose a scheme of home protection that acts as a perverse incentive to encourage people to go into residential care?

Stephen Dorrell: With respect to the Minister, I did not say that we are in favour of a direction of travel that provides free personal care to people living at home; it is important that I make that clear. What I said was that we favour a direction of travel that encourages people, on a realistic funding basis, to live at home. That point has been made by the Minister and several others in the course of this debate. We want a funding basis for social care that encourages people to live at home.
	The Government, however, are saying, "If you live at home, the taxpayer will pay." That is great, except that it means that the formula for the delivery of social care that we all favour is the one that is cash-limited. Ministers may not agree with this, but the hon. Member for South Thanet has said again today-and I whole-heartedly agree with him-that the formula for the successful delivery of social care that meets the underlying demand at a quality level that we would want to deliver has to involve a form of co-payment. That element of flexibility has to be in the scheme if in the years immediately ahead we are to be able to deliver the quality of social care that we want at affordable cost.

Stephen Ladyman: I reaffirm again that I agree that a form of co-payment has to be made. I regret that we have had to come down this road so quickly, because it has not been possible to get consensus on the form of co-payment. If the Conservative party had at any point during the Green Paper discussions suggested that it would consider some form of compulsory co-payment as well as the voluntary co-payment schemes in the Green Paper, there might have been a basis for discussion, but the Conservative party said it would only consider supporting voluntary schemes. On that basis, there can be very little likelihood of arriving at a consensus.

Stephen Dorrell: As I have said, I have great respect for the hon. Gentleman in this area, but I do not understand the logic of what he just said. He says that he believes, as I do, that the successful delivery of social care requires co-payment, and he then says that agreement could not be reached with the Conservative party. I do not know what discussions took place between the Front-Bench teams, but I know that irrespective of whether those discussions were successful, he is using that as an excuse to justify a formula for the delivery of social care at home that does not rely on co-payment at all. It contains no element of co-payment; it is fully taxpayer-funded, and that is what makes this model unsustainable.
	I make the point again, because it is important, that this approach creates a completely perverse incentive. The hon. Gentleman and I agree that providing the necessary flexibility for a realistic funding package for social care must involve co-payment. In the Government's view of the world-if this Bill is passed-where does co-payment apply in the social care context? The answer is only in a residential care context. In other words, the Government are setting up a formula that will restrain the ability of people to live at home, because the taxpayer will not be able to afford it, and that will, at the margin, shift people into residential care, because that is the basis on which the funding formula will work.

Norman Lamb: Does the right hon. Gentleman agree that this approach provides not only a perverse incentive, as he describes, but a central unfairness, in that someone who has critical needs and who is at home gets their care paid for fully but someone who, through no fault of their own, has to be cared for in a care home does not? That is unfair.

Stephen Dorrell: I agree completely with the hon. Gentleman, and I sought to focus on that point in our debate on the earlier group of amendments. By creating this distinction between personal care delivered at home and personal care delivered in the residential context, we will create a cliff edge. As one group will be cash-limited, because the Treasury is extremely cash-constrained and likely to become more so, and the other group will be less cash-limited, we will create a completely perverse incentive in the direction of the residential context, not the care-at-home context.

Lee Scott: The Select Committee on Health, on which I am honoured to serve, is examining this area and taking evidence. The crux of the matter is that its suggestions might be of use to this debate, might provide a way forward for the entire Bill and might answer some of the questions that my right hon. Friend has rightly raised. Does he agree that its suggestions could provide some of the answers to these problems that we are debating?

Stephen Dorrell: I agree entirely with my hon. Friend that all the work of the Health Committee and, indeed, of those who are formulating responses to the Government's Green Paper on social care policy development-presumably, that was one of the things that prompted that Committee to engage in its inquiry-is being pre-empted by this proposal. This measure is extremely good news and I understand why the Minister thinks it is popular among those who will benefit from the care that will be provided free. He said in his response to the earlier debate that we cannot wait until we can create a perfect world before moving forward, and I agree with that. However, when a Government move forward on an incremental basis, the Minister has an obligation to recognise the consequences of the incremental stages, step by step. That is the basis of the charge that I set at the Government's door; it is not that this proposal is undesirable for the people who will benefit from it-of course it is desirable for them-but it will create a series of perverse consequences and perverse incentives, several of which have been mentioned in this debate. I suspect that the Minister and his officials have probably thought those through and thought, "Oh goodness, how do we put a gloss on this?" However, nobody in No. 10 has properly thought them through.

Stephen Ladyman: I wish to clarify again for the right hon. Gentleman the point I was trying to make. Because the Conservative party has drawn a series of red lines that it is not prepared to discuss, according to all its public statements, it was clear to the Government that a consensus could not be arrived at in anything like the near term. A group of people with very serious needs-people with Parkinson's disease and Alzheimer's being the primary ones-are struggling at the moment, so as it was clear that we were not going to get agreement on the comprehensive package and the methods of co-payment to fund it, on which he and I agree, this Bill was necessary in the short term to address their short-term needs,.

Stephen Dorrell: I invite the hon. Gentleman simply to consider the point that I have just made: what will be the consequences of each incremental step that he is inviting us to take? If he agrees with me that the consequence of this policy formulation is to create an incentive in favour of residential care rather than care at home, for the reasons that I have set out, and if he agrees that in the long run we must provide a funding base for social care that includes co-payment, all I will say to him is that if, perchance, there were a Labour Government after the election-I profoundly hope that there is not-and if he were a Minister in it, I would look forward to hearing him make a speech from the Dispatch Box that explained to the House why it was a good idea to have free personal care ahead of the election whereas after the election that would evolve into a system of payment through co-funding for personal care delivered at home. That is the policy that I believe that he supported until the Prime Minister made his statement at the Labour party conference, and I believe that any incoming Labour Government would have to revert to it after the election-perhaps even before October 2010.

Stephen O'Brien: I am most grateful to my right hon. Friend for giving way before he moves on from his quite proper riposte to and, to some extent, rebuttal of the statement made by the hon. Member for South Thanet (Dr. Ladyman). In his earlier intervention, the hon. Gentleman justified the necessity of introducing the Bill, notwithstanding his adherence-quite rightly-along with the rest of us to the process of the Green Paper, suggesting that it was somehow impossible to obtain consensus and that it was all the Conservatives' fault. He prayed in aid the idea that there was no consensus because we Conservatives were not prepared to sign up to compulsory contributions. That has been a concern for us, and we have certainly found a way forward with voluntary contributions. However, the Government have not said that they are in favour of compulsory contributions either. On the contrary, they have said that there is a Green Paper process and that they have not come to any kind of conclusion. It is impossible for the hon. Gentleman to assert that any consensual discussions have collapsed when there have not been any such discussions. Moreover, the reason that he prayed in aid was not even proposed by his Government.

Stephen Dorrell: I agree with my hon. Friend and repeat the point that I made in my earlier response. It is odd to say, "The Conservatives would not agree with us on a voluntary co-payment basis, so we are going to go to a fully tax-funded model." I simply do not understand-

Stephen Ladyman: rose-

Stephen Dorrell: I shall give way to the hon. Gentleman one more time, but I think that I have given him enough lives on this subject.

Stephen Ladyman: I have been very grateful. I want to put a point to the right hon. Gentleman on which I think we can both agree. Yesterday, the Liberal Democrats were 100 per cent. in favour of free personal care for everybody and today they appear to be totally opposed to free personal care for anybody.

Stephen Dorrell: It is worth inviting the House to work out how long it is since Northern Rock or the Lehman Brothers collapse, and how long it has taken the penny to drop in the Liberal Democrat mind that the world has changed. Anyway, it is nice to see that the Liberal Democrats are back in sight, probably, of the land of reality. They are not there yet, but they are working their passage back. We look forward to welcoming them there again at some point in the future.
	I have talked about the need to put a safety valve into the system, which is why I believe that my hon. Friend the Member for Eddisbury took the unusual step for an Opposition spokesman of proposing a Henry VIII clause. We have already touched on one other element to which I want to return, because it is important. It relates to the earlier amendment tabled by my hon. Friend. In response to the definitions of which residential units would qualify for free personal care and which would not, the Government were at pains to say that extra care housing constituted "home" but that a care home without nursing did not constitute "home". One does not have to be a great expert in this area to work out that if there is one category of "extra care housing" and another of "care home without nursing", they will fall on different sides of the dividing line. The Secretary of State will need a regulation-making power, and what is more he will need to use it on a weekly basis, roughly, to keep the definitions of those two categories separate in a way that would maintain the viability of the policy.
	My hon. Friend the Member for Eddisbury has tabled the amendment in recognition of the fact that the Government are creating a policy context that will be fraught with anomalies and difficulty. The only way that it could possibly work would be if Ministers had the power to change the law virtually on a weekly basis-I use the phrase again-to prevent pressure from building in a way that would make the system unsustainable. That is particularly true given the Government estimate that the policy will cost £537 million. My hon. Friend the Member for Ilford, North (Mr. Scott) has already made the point that half of that cost would be unloaded on local authorities with no additional money being provided to them. I have talked to local authority leaders of my acquaintance about this issue. To believe that they will have sitting around in the next few years the kind of money that will be needed to meet the additional burden that the Government have imposed on them, and that they will not need additional resources, is simply to live in Liberal Democrat land.

Robert Syms: I have no great disagreement with amendment 11. I have thought about it, asked a few friends about it and I am perfectly happy with it.
	I think that amendment 12, which is a Henry VIII clause, is well drafted. I am not sure whether we fully understand the implications of the Bill. We have heard from the Minister that there will be a sort of big bang approach and that by this October all care will be free. We have also heard about the financial arrangements for local authorities, and I am not sure how robust they will be. I suspect that there might well be arguments, case law and disagreements on this issue, so it would be quite useful to have the ability to amend the legislation-even by regulation, whether by negative or positive procedures-as we do not know how this story will unfold.
	My right hon. Friend the Member for Charnwood (Mr. Dorrell) has set out some of the difficulties regarding definition, and, at some point, the House might need to introduce regulations to make the system more workable. If we create a cliff edge by saying that care is paid for for those who stay at home but not for those who go into a care home, which means that some in the latter category might have to sell their home, we will be creating a pretty big incentive for families to try to keep people out of care homes. Given that the nature of the debate will change, we need a Henry VIII clause, and amendment 12 provides that perfectly well.
	In terms of public policy, I would be more confident about the way that things will unfold if I had more confidence in the financial arrangements. I referred earlier to the potential £250 million to be found from savings. When we get to October, real money coming into local authorities will suddenly disappear; they will still have to fund the cost of care, but they might not have the resources to do so.
	We have not discussed whether there might be a case for transitional arrangements, or whether there will be enough people to provide services to people in their own homes. Amendment 12 is therefore important, because it would enable the Secretary of State to return to the House with legislation covering new circumstances arising from the changes to home care introduced by this Bill that we cannot predict or fully understand at present.
	As was mentioned earlier, the Health Committee is to produce a report in due course that may inform the public debate. If amendment 12 is adopted, that report may result in further changes.
	The Government are consulting and may have to provide guidance. Will that guidance be presented through a statutory instrument, or will it have no statutory basis? We need to hear how the Minister intends to proceed. It would be useful if, when he sums up the debate, he takes the opportunity to set out what consultations and guidance the Government are undertaking. When does he expect the results to be reported? We need to be fully aware of the shape of things to come.
	Amendment 12 is useful, although I agree that Oppositions do not usually propose Henry VIII clauses. However, events may unfold in ways that we do not expect and, as I pray and hope, we may well form the Government after the next election.

Stephen O'Brien: In the light of the contributions made by my hon. Friend and others, and in advance of the Minister's remarks in reply, it might be helpful for me to confirm that this is, in fact, a probing amendment and not one that will be forced to a Division. I believe that the amendment has led to an extremely helpful discussion, and I hope that what I have just said has changed the tenor of the debate on this particular group of amendments.

Robert Syms: That is useful information, although I may call the vote myself.
	I think that amendment 12 is useful, not least because it gives the Minister the opportunity to set out what the Government are going to do in a little more detail, and because it looks forward from where we are today to the big bang approach in October. It is very important that more information is put into the public domain. The scheme's shape and funding must be made clear to local authorities. Its success or failure will not rest on whether Whitehall pulls a lever, but on lots of hard-working people in local authorities around the country being able to support and implement it in the way that the Government intend.

Phil Hope: We have had an interesting debate on this amendment. My hon. Friend the Member for South Thanet (Dr. Ladyman) described it as an "open ended carte blanche free hand to redesign the whole of the personal care system by diktat"-what a temptation that possibility offers! It is very strong, but unfortunately I am unable to support this probing amendment.
	A number of important points were made in the debate. In moving the amendment, the hon. Member for Eddisbury (Mr. O'Brien) once again challenged the extent to which the Bill and its proposals for free personal care for people at home with the greatest care needs were congruent with the Government's thinking on developing a national care service. I am absolutely convinced that it is a step along that path, as I said in the debate on the previous series of amendment. I set out then everything that we had done over the past 12 or 18 months to develop and improve this country's social care system, and I think that this proposal is simply another feature of that.
	The amendment would allow a future Conservative Government to introduce changes to the care system, but the remarks made by the hon. Member for Eddisbury let the cat out of the bag. From what the right hon. Member for Charnwood (Mr. Dorrell) said, it is clear that the Conservatives see what the Government are trying to do as a perverse incentive and an anomaly. I cannot think why the right hon. Gentleman would want to put out a leaflet with his name on it in my constituency, saying that providing free personal care was an anomaly, and perverse.
	I shall have to check  Hansard to make sure that I wrote this down correctly, but the hon. Member for Eddisbury said, "We do not want to encourage a policy of free personal care for people in their own home. This is not the direction of travel of Conservative policy." It is interesting that the amendment has flushed out what I think is the true intent behind the Conservative position on these matters.

Stephen Dorrell: The Green Paper stated that free personal care was an unaffordable option. Is that still the Government's position?

Phil Hope: We are, of course, seeking to develop our proposals for the creation of a national care service. We are building on the best practice that I know goes on up and down the country. That includes things such as greater integration of the health and social care systems or, as we discussed earlier, making sure that people get direct payments, because we believe that personal budgets give people more choice in and control over their care.
	In developing our thinking for the future White Paper, we are looking at all the options, just as we did with the Green Paper consultation. We will also look at ways to take those options forward.
	It is true that there are problems with funding the whole of the care system in full through the tax paid by people of a younger age. I have made that point before in this House: the hon. Member for Eddisbury has repeated my remarks, and I am happy to repeat them again in this debate.
	There has been a demographic change in our population. Where there used to be four people of working age to one elderly person, over the next few years that will become only two. It will simply not be sustainable to maintain a system of care provision by taxing those people, but we will bring forward our solution to that problem when we set out our proposals for a national care service.
	In the meantime, I am not prepared to stand by and see people in their own homes with the highest level of care needs-and people at the critical level need help with four activities of daily living-having to run down their savings and drawing on the help of loved ones to pay for the support that they need.
	That is why the Bill is important, and I am disappointed that the Opposition do not seem to support what it proposes. I am also disappointed that the Liberal Democrats have decided to drop their pledge to provide free personal care for older people.

Stephen Dorrell: I am very grateful to the Minister for giving way. I asked him a very simple question, and I listened to his reply extremely carefully. It was a long reply, but I think that it can be accurately summarised. It is that the Government still believe that free personal care for everyone is unaffordable.

Phil Hope: We will have to have that debate when we bring forward our proposals for a national care service. The questions will be to do with how we take those proposals forward, and what is a fair, affordable and simple system for providing better care for people, both in their own homes and in residential institutions as well. That is a debate that we will initiate in the near future, and I am looking forward to having it.
	The right hon. Member for Charnwood said that our proposals were anomalous and acted as a perverse incentive, but when I challenged him he was unable to defend the home protection scheme that the hon. Member for Eddisbury proposed. That proposal is a private insurance scheme which, to protect a person's home-hence its name-covers only residential care. The costs are paid up front, although people need to have £8,000 to be able to afford it. It is optional-in other words, not everyone will take part in it-and partial. I have no doubt that it will exclude people with any underlying health condition, as they would not be able to get such insurance for the price £8,000.
	The hon. Member for Eddisbury is going to struggle to sell his home protection scheme, because it would merely provide a small amount of support for a minority group of wealthy people. If he thinks that that will win him the next general election, he has another think coming.

Stephen O'Brien: I wish that the Minister would not assume anything about other people's policies without having studied them. The proposal does not make any exclusions for underlying conditions. All that has been subject to proper actuarial pricing.

Phil Hope: That is even more intriguing. We are seeing the policy crumble as the hon. Gentleman speaks.
	There has been talk of consensus, although the hon. Member for Eddisbury has spoken about how he has not been involved in any such discussion. However, it is a little tricky to try and build consensus when the Opposition decide to run an underhand and irresponsible campaign on their website suggesting that the Government are intending to cut attendance allowance and disability living allowance for older people. That is simply not true, yet the Opposition continue to run their campaign. It is a form of politics that generates anxiety, uncertainty and fear among older people, and does not fit with the party's claim to be compassionate and progressive. If they carry on with such scaremongering, the Opposition will build no consensus with Labour.
	If amendment 12 is a probing amendment, I do not understand the impact that it might have on particular groups. I have made it clear that the intention underlying the Bill is that people with the highest care needs should be supported to live at home. I want to make it clear that we think it is important that adults who are part of an adult placement scheme do not miss out on this opportunity, so it is important to make it explicit, even if we do not do so with a broad set of regulations that the hon. Member for Poole (Mr. Syms) would welcome, that for the purpose of the Bill, adults on an adult placement scheme, who are often adults with learning disabilities who live with another family, are to be considered as living at home.
	In our opinion that is the only situation that is required to be excepted from the six-week restriction on the free provision of personal care in accommodation where care is provided as an integral part of that accommodation. In other situations, it should be clear that people are living either in accommodation where care is provided as an integral part of that accommodation and are not eligible, or are living at home and may qualify for free personal care. So to give the Secretary of State further regulation-making powers, as described in amendments 11 and 12, although attractive, is unnecessary. I therefore ask the hon. Member for Eddisbury to withdraw his amendment.

Stephen O'Brien: The debate has been useful and necessary to help elucidate what we are all trying to achieve-a much more holistic approach to the reform of social care. I confirm that, as I made clear in an intervention, the amendment was a probing amendment. I beg to ask leave to withdraw the amendment.
	 Amendment, by leave, withdrawn.

Stephen O'Brien: I beg to move amendment 13, page 1, line 17, leave out
	'(including the exercise of a discretion)'.

Sylvia Heal: With this we may take the following: amendment 16, page 1, line 20, at end insert-
	'(c) exempt a local authority from providing personal care free of charge to a person eligible for or in receipt of continuing care.'.
	Amendment 41, page 2, line 9, at end insert-
	'(5A) After subsection (4E) insert-
	"(4F) The Secretary of State may by regulations authorise a local authority to make transitional arrangements for a person moving from or to accommodation that an establishment provides to the person together with the care."'.
	New clause 5- Portability of care packages -
	'The Secretary of State shall make regulations to introduce a standardised assessment process to ensure portability of care packages between authorities.'.

Stephen O'Brien: I confirm that amendments 13 and 16 are probing amendments, the former about what the discretion in the Bill might entail, and the latter about how the policy will work in respect of continuing care funding. It is vital to obtain clarification from the Government on both issues. I hope the Minister will be able to tell me and the rest of the Committee what discretion is referred to in proposed new subsection (4B)(a).
	On amendment 16, in the last quarter almost 45,000 people across England were in receipt of continuing care-a number that is likely only to increase. It represents about 10 per cent. of the total number of NHS beds in the country. What proportion of those would qualify as FACS critical? FACS is shorthand for the fair access to care services guidelines published in 2003 to provide councils with a framework for setting their eligibility criteria for adult social care, and thus to lead to fairer and more consistent eligibility decisions across the country.
	The guidelines are being revised in the light of the Commission for Social Care Inspection report entitled "Cutting the Cake Fairly" and give the criteria for low, moderate, substantial and critical categories. The Bill deals only with those with critical assessed need. I assume that many of those in receipt of continuing care would qualify as FACS critical. If that assumption is right, will not the policy of free personal care seem to primary care trusts the perfect opportunity to offload people back on to local authorities? That is important, particularly as we face such tightened fiscal and financial conditions in the coming months and years. Whether the Minister or any of us likes it or not, there will be temptations for anybody in charge of a budget to see where they can offload their responsibilities.
	Will the Minister also clarify whether the Coughlan judgment in the Court of Appeal in July 1999 makes the NHS specifically, or the state in general, liable for the funding of care, so long as it is free? The continuing care funding question points to a wider question of how the policy will work across the health and social care divide. Could the free personal care fund be rolled up into a joint budget?
	Given that we are talking about the crossover between NHS and social care, will the Minister give some clarity to the noise that we have been hearing in the  Health Service Journal about the Secretary of State's plans to hand social care over to the NHS in toto, in order-in the words of an "unnamed source"-to
	"rip the heart out of Tory councils"?
	He seems to have retracted from that position, I am glad to say, but is now saying:
	"I'd feel very comfortable with primary care trusts increasingly merging functions with adult services."
	The Minister hinted at something along those lines in response to the previous group of amendments. That is nothing new. Its progress has been hindered so far only by the Government's constant reorganisation, as we have argued, of the institutions within our NHS. I am glad to see that the Secretary of State said last Thursday in his evidence to the Health Committee:
	"I am an integrationist on health and social care."
	I look forward to the Minister's progress reports on that.
	Amendment 41 addresses transitional arrangements. I promised the hon. Member for South Thanet (Dr. Ladyman) that we would return to that. Has the Minister thought about how transition might work, particularly as people will be moving from free care to care for which they are charged? Transition also raises the question of what happens if someone ceases to have critical care need. The Minister has confirmed in written answers to my parliamentary questions:
	"Councils are under a duty to regularly assess"-
	let us leave aside the split infinitive-
	"an individual's needs",
	and that if no longer critical,
	"they would no longer be eligible for free personal care."-[ Official Report, 8 December 2009; Vol. 502, c. 295W.]
	We are not talking about individuals who might get a bit better. We are talking primarily, I suspect, about the councils that might get a bit tighter. That is the worry. Has the Minister thought through both the pressure on individuals and the administrative problems for councils that will arise? I hope that in his response he will take the opportunity to spell out the details on the record.
	New clause 5 was tabled by the Liberal Democrats. We look forward to hearing about the portability of their policy positions, given yesterday's announcement. In the light of their wish to reject their pledge of free personal care, how do they regard the funding of portability against standardised assessment needs? That is the issue presented in the new clause that will have to be addressed, not least because the right hon. Member for Sheffield, Hallam (Mr. Clegg), as I understand it from yesterday's announcement, either downgraded or scrapped the £2 billion unfunded care guarantee that the Liberal Democrats announced when he became the leader of his party.
	Leaving aside the various policy position changes, the serious point about new clause 5 is the postcode lottery that continues to exist across the country. Up till now, the Government were happy to say that that was the price of localism. There is a discomfiture that we are all caused by the tension between wanting to give local decision-making autonomy and ensuring that that does not result in unfairness, in the form of postcode lottery provision.
	Last week the Secretary of State said that there were "limits to localism". Is he planning to abolish councils, or their powers in the process, as part of his way forward? It can be very disconcerting for people when the funding that they receive from one local authority is not matched by funding from a new authority that they move to. Can the Minister assure the Committee that anyone assessed as critical by one authority will be assessed as critical by all other authorities? As I pose the question, I think that the difficulty is apparent.
	I am sure that the Minister has studied our proposals for common standards of assessment of need, which would be very helpful. If he wished to adopt that policy, we would be more than happy to let him do so. The case for new clause 5 will be presented by the Liberal Democrats. I urge the Committee to support all the other amendments.

Stephen Ladyman: I am rather sad to hear the hon. Member for Eddisbury (Mr. O'Brien) saying that this is a probing amendment, because I am quite attracted to the idea of removing discretion from local authorities in this matter. I also have a certain sympathy with the Liberal Democrats' new clause. If we are going to create a national care service, we shall have to create a common way of assessing people's needs and a common set of criteria against which to assess them, as was made clear in the Green Paper.
	One aspect of this that none of the Front Benchers has tackled-the elephant in the room, perhaps-is that we will get genuine portability only if there is agreement on a standard level of funding. In other words, someone's condition would need to be assessed in the same way wherever they were, and they would then need to be funded at the same level wherever they were. That would take an awful lot of discretion away from local authorities.
	This is going to be a difficult matter to tackle, but it must be tackled when we come to the White Paper. Although I do not believe that it is appropriate to address these matters in the Bill, I would like to hear my hon. Friend the Minister say that he understands that we are going to have to work to resolve them. I would like to suggest to him that, as well as having standard assessment criteria for people wherever they live, we might take the step, which I suggested on Second Reading, of making it compulsory for social care to be delivered from an adult care trust, in which the local authority and the local NHS are made to pool their resources and work together to deliver that level of care. That would go a long way towards resolving the tension between localism and the need to have a standard package of care everywhere. It would also help to bring NHS resources into focus in regard to delivering this care.

Laura Moffatt: Does my hon. Friend envisage such a trust working in the way in which some of the very good, effective children's trusts are beginning to do? In them, people from different organisations and parts of the caring professions are really working together for the sake of the child. Does he believe that that would work in an adult trust?

Stephen Ladyman: Yes, absolutely. There are already good examples around the country of older people's trusts being set up. Torbay is a good example.
	I had a conversation today with the Royal College of Nursing, which is concerned about how our community nurses will be involved in these provisions. I know that that subject is close to the heart of my hon. Friend, as she is a former nurse. If such adult care trusts were set up, community nurses would have a role in monitoring the care provided for people, either in their own homes or elsewhere. Those nurses would become more involved in the delivery of care, as well as in providing access to the resources of the national health service. They would be providing their skills alongside those of social workers from the local authority.

Stephen Dorrell: I agree with quite a lot of what the hon. Gentleman says about the benefits that can come from integrated trusts. Such trusts can ensure that an integrated service is delivered to an individual service user. Does he agree, however, that we should guard against believing that that is the only model that works? There are others that work equally well elsewhere in the country. Does he also acknowledge the danger of believing that, if something works well somewhere, all the problems will be solved if a Minister simply signs a piece of paper and insists that it should be done like that everywhere? Surely to goodness, the history of the past 30 years must demonstrate that that approach does not work.

Stephen Ladyman: The right hon. Gentleman is right: we should have an open mind on what the right model is going to be as we move forward in these discussions. Whatever model or models we choose will have certain characteristics in common, however. One will have to be that the local NHS and the local social care services work closely together and that they have access to and flexibility over each other's funds. We must not minimise the difficulty of achieving that, however. I have said many times on the Floor of the House and in other forums that the only significant area of local government funding that is not ring-fenced for spending in a particular way is the money that the Government give to local authorities for adult social care. If we were to ring-fence that funding, we would take away a great deal of the localism, as we like to call it. We are going to have to address that issue as well, if we want to tackle this problem.
	That is beyond the scope of the Bill, and of the amendment, however, and I believe that you would leap up and bring me to a halt if I went down that road, Mrs. Heal. I shall simply say that I am tempted by some elements of the amendments in this group. They deal with matters that we are going to have to face up to in the near future. I do not think that they are appropriate for this Bill, but if we reject them today, we must not reject them for ever.

Greg Mulholland: I wish to speak briefly to new clause 5, which proposes:
	"The Secretary of State shall make regulations to introduce a standardised assessment process to ensure portability of care packages between authorities."
	That really is as simple as it sounds, but it is fundamentally important. I am seeking the Minister's reassurance that the proposal will be taken seriously, and perhaps looked at in the Lords. If that can happen, I will not press it to a vote. If not, I would be minded to do so.
	The purpose of the policy behind the Bill is very simple. I have said that it offers only a partial solution, but it does guarantee free personal care for those with critical needs who live in their own home. In that case, surely someone who has been deemed to qualify under the terms of the policy should not be penalised if they move. People move to be closer to members of their family, for example. This applies often, but not exclusively, to older people, who move in order to get care from family members or to gain emotional support and greater contact.
	I am sure that hon. Members have heard of many cases of people moving to a different area and having to jump through hoop after hoop, simply to receive the same level of care that they had been receiving before. It is bureaucratic nonsense, as well as a real injustice, when people with real needs are prevented from accessing the kind of care that they had been used to, simply because they have changed their postcode. It would be quite wrong for people to face that threat, as they might if the new clause were not introduced. Again, I ask the Minister to reassure me that that will not be the case. People could become marooned in a local authority area, afraid to move closer to their family or some other support network because they would have to go through yet another assessment process.
	There are also costs associated with such reassessments. One can understand why a local authority might want to assess every new person moving into its area, but it does not make sense to do so if the assessment processes are as robust as they should be. A local authority should be able to accept the assessment or reablement process that has already shown that a person qualifies for free personal care at home. I firmly believe that we are talking about a very important element of the Bill, and I am concerned that this measure may be a flaw in making it work and a restriction on its potential positive impacts. I urge the Minister at least to reassure me and the Committee that that will be taken very seriously when the Bill goes to the Lords.
	I am disappointed that the Conservatives, rather bafflingly, have chosen not to support the new clause, because it would not involve costs but in fact reduce costs at local authority level. If a local authority insisted on going through an unnecessary assessment process merely because it wanted to keep its own costs down, that would not make sense. The hon. Member for Eddisbury (Mr. O'Brien) chose instead to make rather spurious party political points, which had the whiff of hypocrisy about them given the criticism that the Minister and the Government have received to the effect that this is simply about electioneering. Let us at least be a little sensible when we are talking about such serious matters.
	I do not wish to push the new clause to a vote. However, can the Minister reassure me that it very much reflects part of the Government's thinking and that the measures in the Bill will not be undermined but will work in the way that he has told us they will?

Tom Clarke: This has been an interesting debate. I want, if I may, to focus on the aspects that have dealt with the role of local authorities, with particular reference to amendments 13 and 16.
	If the hon. Member for Eddisbury (Mr. O'Brien) had the same objectives as my hon. Friend the Member for South Thanet (Dr. Ladyman), I might even be convinced myself by the argument on continuing care, but I have to say, in all candour, that I am not. What we have established here today, perhaps not for the first time, is the existence of a big difference between the Conservatives and Labour in terms of how Governments work with local authorities. I cannot envisage a situation in which, in the absence of joint planning between local authorities and the NHS, we can deliver the kind of personal care that we have all agreed on.
	In relation to amendments 13 and 16, I am afraid that I must be even more ungenerous to the hon. Member for Eddisbury. Amendment 13 seeks to limit the discretion of local authorities in setting the eligibility criteria for free care. The Conservatives frequently condemn direction from Whitehall and extol the virtues of localism and local control, yet they then table amendments that would remove local freedom. I am not at all persuaded by that approach. I think that this is an essential argument about what sort of democracy we want to live in. Given that day after day, week after week, we meet councillors, directors of social services and others who have to implement our decisions, we should be a bit clearer than these amendments suggest about the very important role that local authorities play.
	Amendment 16 seeks to exempt local authorities from providing free personal care for those in a state of continuing care. If we spell that out, it means, in effect, extended care for a person over 18 to meet physical and mental health needs that have arisen as a result of disability, accident or illness. The amendment is difficult to understand if we take the view that we are to have a relationship between central Government and those responsible for delivery. I have never accepted that local authorities should see themselves as enablers rather than providers, which the hon. Member for Eddisbury hinted at. There will always be a case for both things on the part of central Government and on the part of local government, and that should be recognised.
	The amendment would exempt a section of the most vulnerable people from receiving free personal care at home because they are in receipt of continuing NHS care. I ask this question: why? I have not heard a convincing argument for it. If highly vulnerable people were to be treated in this way, significant costs to pay for care at home would arise. They should be entitled to the same support as everyone else in that group. The fact that they are receiving additional care from other sources such as the NHS should not take away the relevance of addressing their problem, having proper assessments, having a greater degree of advocacy than we have managed to discuss today, and delivering to those who need the personal care that I believe is so essential.

Paul Murphy: I want briefly to follow my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr. Clarke) by speaking to new clause 5, for which I have some sympathy, in relation to the portability of care packages.
	I should like to talk about the extent of the Bill in so far as local authorities are concerned. Presumably, we are referring to English local authorities, not to Welsh ones, although the Bill extends to England and to Wales. I am slightly troubled about the view that the national care service that we are rightly discussing will be universal throughout the United Kingdom. I would not dream of talking about Scotland; however, in terms of the Bill's application to Wales, I am not yet convinced that there has been sufficient dialogue between Welsh local authorities and the Welsh Assembly Government about how this might operate. I believe that the Welsh Assembly Government would be very agreeable to the principles of this excellent Bill, and indeed some of its details. I hope that my hon. Friend the Minister can give me an assurance that proper discussions are taking place between Welsh local authorities, the Minister for Health and Social Services in the Welsh Assembly and, indeed, the Welsh Local Government Association about the parts of the Bill that impinge on the duties and activities of English local authorities.
	In relation to the portability of care packages between English local authorities, there is a tremendous amount of movement across the English-Welsh border. Many people would find themselves in the same position as if they were to move from Derbyshire to Lancashire, as opposed to going back and forth into Wales from Gloucestershire or Merseyside. There are genuine cross-border issues, but also a worry that while benefits are UK-wide, the detail of local authority involvement in this package is for England only.

Stephen O'Brien: I am most grateful to the right hon. Gentleman for allowing me to intervene. He is making a very important point that is, to some degree, covered in amendment 28; if we are fortunate enough to reach it, he might want to take the opportunity to explore this a bit further. I endorse some of what he says, speaking as the representative of a constituency with a Welsh border, where there are many incidents involving people travelling across the River Dee to access some form of health service, continuing care, social care or acute services. That is causing a pretty big nightmare for all those of us concerned.

Paul Murphy: Yes, indeed. Over the past few years, in my ministerial capacity, I have been able to try to resolve some of those issues, although it is not easy.
	I ask my hon. Friend the Minister for an assurance that there is proper dialogue and discussion between the Welsh Assembly Government and Welsh local authorities with regard to these issues.

Phil Hope: Members have raised a range of issues, and I shall try to deal with them all. Amendment 13 would limit the functions that may be imposed on a local authority through regulations by removing reference to their
	"including the exercise of a discretion".
	That could severely reduce local authorities' ability to manage the costs of care. They are best placed to judge what is appropriate in their own situation, depending on their clients and the availability of their services. It is right that functions imposed on local authorities relating to eligibility for free provision should include the exercise of discretion, so that they can effectively manage the provision of free personal care in their local area.
	The Bill will enable the Secretary of State to make regulations in specific circumstances, constrained by their having to relate to the provision of free personal care in certain settings. I draw Members' attention to the current consultation document on various regulations and guidance. I shall come to that in relation to new clause 5 in a moment. We need to include in the Bill the power to ensure that local authorities can properly be given a discretion, which will be specified in regulations. I urge the Committee not to support amendment 13, because we need to enable the Secretary of State to issue appropriate regulations.
	Amendment 16 would enable regulations to exempt local authorities from providing free personal care to those eligible for or in receipt of continuing care. Continuing care means care provided over an extended period to a person aged 18 or over to meet physical or mental health needs that have arisen as a result of disability, accident or illness. An individual who needs continuing care may require services from NHS bodies and/or local authorities, and local authorities should also be able to provide free personal care to such people if they qualify for it. Where personal care is provided at home as part of a package of continuing care that it falls to the local authority to provide, there is no reason why the local authority should not be required to provide it free in the same way as personal care that is not provided as part of a package of continuing care. If an individual is entitled to services as part of NHS continuing health care, their package of care will be provided solely by the NHS and not by the local authority.
	It is important that NHS continuing care and free personal care are recognised as different ways of delivering health and social care. In all cases in which it appears to a primary care trust that there may be a need for NHS continuing health care, the PCT has a duty to take reasonable steps to ensure that an assessment of eligibility is carried out. I hope that that directly addresses the concern of the hon. Member for Eddisbury (Mr. O'Brien).
	On the Coughlan case, the position was confirmed in directions issued by the Secretary of State after the judgment. If a person is assessed for physical and mental health services under continuing care, that package should be provided solely by the NHS when the primary need is health-related. I hope that that clarifies the relationship between the two sets of funding.
	Amendment 41 would provide the Government with regulation-making powers to authorise local authority transitional arrangements when a person moves to or from care home accommodation. Extending free personal care to care homes to cover transitional arrangements is outside the policy proposals that inform the Bill, which is about personal care at home, not care in a care home. Extending the policy as the amendment suggests would also substantially increase the costs of providing free personal care beyond the agreed financial envelope. For that reason, we cannot support it.
	The hon. Gentleman talked in passing about a slightly different issue of transition-people who qualify for free care in their own home but whose situation improves to the extent that they may no longer need it. We believe that it would be unreasonable to continue to provide it. People are regularly assessed as their needs change, and that would apply in the circumstances that he described.
	New clause 5 would place a duty on the Secretary of State to make regulations to introduce a standardised assessment process for free personal care, so that a centrally standardised process could ensure that care packages were portable between different local authorities. I hope that I can reassure the hon. Member for Leeds, North-West (Greg Mulholland) and others who expressed support for the idea. We believe that to make free personal care fair and simple to understand, it will be necessary to develop a standardised assessment tool to assist councils in applying the eligibility criteria fairly, which I believe is exactly what the new clause is designed to achieve. We have already suggested that in our consultation document on regulations and guidance. I draw the hon. Gentleman's attention to page 16, which describes our intention to develop a standardised assessment tool for that purpose. That will be set out in regulations and guidance that will accompany the Bill, and we will begin commissioning for such a tool very shortly, so we do not believe it is appropriate to include that level of detail in primary legislation.

Greg Mulholland: That certainly goes some way towards reassuring me, but will the Minister be specific? Once an individual has gone through the standard assessment process in one area, will it not need to be done in another area? That is the key question.

Phil Hope: It will be a standardised assessment tool described in regulations and guidance. There will still need to be local application of it, but the tool itself will be standardised in the way that I believe the new clause describes. That is what we are consulting on now through the consultation document. I hope that that reassures the hon. Gentleman that we understand the need that he describes.
	That is a slightly different point from the one about the fair access to care criteria, which the hon. Member for Eddisbury mentioned. We have just completed consultation on fair access guidance, because there was concern that the level of local interpretation was such that unacceptable differences between areas were being created. New guidance, based on the consultation that we have put out, will be issued in March and will reduce the level of interpretation-I would describe it as misinterpretation-that was allowing for those differences. The combination of the revised guidance and the new standardised assessment tool will achieve the outcomes that he and the hon. Member for Leeds, North-West seek.
	My hon. Friend the Member for South Thanet (Dr. Ladyman) took the opportunity provided by the new clause to make a point about the integration of health and social care, and the right hon. Member for Charnwood (Mr. Dorrell) echoed that. It is true that we are seeing different styles and different approaches to that integration in different parts of the country, and the right hon. Gentleman was right to suggest that there is more than one approach. He made some very good points about that. My hon. Friend made a strong bid for a particular model and described its characteristics, and I will take it as a contribution to our thinking about a national care service. It is not a matter for today, but we will have to address the dilemmas about ring-fencing and so on as we go forward.
	I turn briefly to the questions that my right hon. Friend the Member for Torfaen (Mr. Murphy) asked about the applicability of the Bill. I can assure him that we have conversations at official and ministerial level about that, although I would distinguish between the current Green Paper and White Paper developments and the Bill. The provisions in the Bill are only for England, and provisions in relation to Wales will simply give the Welsh Assembly Government the powers to take forward the proposals that we are making, should they wish to do so. We will get to amendment 28 later, but I wish to put it on record now that good practice is exchanged. I understand that the Welsh Assembly Government are consulting on their own Green Paper, and we need to ensure that we collaborate and co-operate across the nations to get the best possible outcome for all involved. We must also deal with the problems that the hon. Member for Eddisbury mentioned of people living very close to the border on either side.
	I hope that I have answered all the questions that I was asked and, given my replies, I ask hon. Members not to press their amendments.

Stephen O'Brien: This has been a useful group of amendments for extracting some helpful information-not least that we should have the result on the FACS problem that I mentioned by March. My question on new clause 5 had nothing to do with any lack of support for it, but concerned our anxiety about the lack of a copper-bottomed assurance that there was no cost differential. That underlines the importance of the Government noting the concern that, as this Bill is rushed through, we do not have even the draft guidance and regulations that will accompany it. That makes a big difference, because it would aid interpretation.
	I hope that the right hon. Member for Coatbridge, Chryston and Bellshill (Mr. Clarke) will give the same weight to my words as he does to those of the hon. Member for South Thanet (Dr. Ladyman). I am sure that, given the values that the right hon. Gentleman seeks to espouse, he would not seek to discriminate as to our credibility just because we travel under different political colours. We used the same language, and the important point to note is that the questions that we asked about transitional and continuing care are difficult and have not gone away despite the Minister's fair stab at answering them. We will have to return to those issues, as they involve relationships with local authorities and whether they have the autonomy to deliver the high quality services that we all want while at the same time ensuring fairness and predictability. I beg to ask leave to withdraw the amendment.
	 Amendment, by leave, withdrawn.

Stephen O'Brien: I beg to move amendment 15, page 1, line 20, at end insert-
	'(4BA) Any local authority not in receipt of funds from central government equivalent to the full cost of providing personal care to people living at home shall not be obliged to provide such care.'.

The First Deputy Chairman: With this it will be convenient to discuss amendment 48, page 2, line 4, at end insert-
	'(4DA) The Secretary of State may by regulations restrict the cost to local authorities of providing personal care to people living at home.'.

Stephen O'Brien: The purpose of amendment 15 is to probe again the £250 million efficiency savings on which this Bill depends. Can the Minister tell the Committee how he has calculated that figure? We worry that, as the impact assessment suggests, he has just plucked that figure out of the air.
	Amendment 48 would give the Secretary of State flexibility to limit the cost to local authorities. The question is who is exposed if the Government have got their calculations wrong? Would it be the Treasury or local authorities? Should the Exchequer-the national taxpayer-bear the costs of any mistakes or should it be local taxpayers or even the recipients of care services?
	The Local Government Association, in its briefing on the Bill, expressed its concern that the Government are not confident about the accuracy of their cost estimates. Many councils have already planned their savings and budgets for the year that the policy will start-2010-11. Councillor Ken Thornber, the leader of Hampshire county council-with West Sussex and Kent, it is one of the Conservative-controlled councils giving a good lead on social care-has said that his council would have to find between £5 million and £10 million above present projections.
	This morning, I received a letter from the chair of the Learning Disability Coalition, Anthea Cox, which stated:
	"We remain extremely concerned at what the implications for local authorities will be in terms of finding £250 million a year from efficiency savings. We are most anxious that these savings do not mean cuts in services for other needy people. It makes no sense to direct extra funding towards people who have their own significant resources as increasing the numbers of people who will become eligible for personal care funding at the highest level of need will reduce the funding available for those with substantial levels of need. There is considerable anxiety where the cuts may be made and the impression that care is being rationed for people with moderate needs. If an outcome of the Bill is further pressure on social care budgets this could well lead to further rationing."
	The blunt truth is that if these savings cannot be found from the efficiencies somewhat loftily urged by the Government-but with no specific plan for achieving a penny piece of them-they will have to come from cuts or increases in charges. The biggest concern is that increases in charges will fall on those with substantial, moderate or low care needs. I asked the Minister in a written question whether charges are likely to be raised. He replied:
	"Setting charges for social care is a matter for local authorities."-[ Official Report, 10 December 2009; Vol. 502, c. 553W.]
	That does not provide much clarification.
	There are equally serious questions about the £420 million central funding. Thus far, the Minister has confirmed that he will cut £50 million from public health campaigns, £60 million from management consultancy, £20 million from administrations costs-that is easy to say, but I wonder whether it will be his administration-and £62 million from research into cancer, dementia and other debilitating diseases. That is worrying given his recent claim that he is seeking to match our promise to increase research into dementia because of demographic changes and the profile of disease occurrence. Those savings add up to only £192 million, so I ask the Minister where the rest will come from.
	Can the Minister explain why the summary of the impact assessment says that the annual enforcement cost of the policy is not applicable, but in a written answer to me on 14 December 2009 he said that it is estimated to be £27 million? How did he make that estimate? Are the illustrative grant allocations weighted, or are they simply produced according to the probable numbers in receipt of care at the critical level? How will the formula work?
	What will the Government do to upskill and, if necessary, grow the work force to meet the demands of this measure to bring care to an extra 100,000 people? That is not strictly a local authority cost, but it will be a local cost. The Royal College of Nursing is
	"very concerned about the impact that these reforms will have on the nursing workforce."
	It claims:
	"These changes will affect the workloads of health visitors, community nurses and specialist nurses-professionals who are already overstretched. The community nurse workforce, in particular, is ageing, with many due to retire in the next 10 years. With only 10 months until these measures come into force the RCN is concerned that there may simply not be sufficient numbers of properly trained social care and nursing staff to deliver the commitment to free personal care in the Bill."
	Does the Minister plan the substantial investment in community nursing that will be necessary if these changes are to be successful? Has he found a source for the funding required?

Greg Mulholland: In many ways these amendments go to the heart of the Bill and its core problems. The Prime Minister announced the policy at the Labour party conference-we all have our views on why it was announced at that time and in that way. The Government announced the shiny, new policy and then said that they would fund only part of it, with the rest of the cost falling on local authorities that are already obliged to find huge efficiency savings-3 per cent. this year, rising to 4 per cent. next year. That is unacceptable, especially given how this policy was introduced. It is supposed to be implemented from October this year, but most councils have already set their budgets for 2010-11. All the savings that they have identified have already been earmarked.
	The impact assessment has been roundly criticised, but the phrase that strikes most fear into those concerned about this area of policy is "inherent uncertainty", which is used about the costs of the implementation of this Bill. Simply to proceed on that basis, and to give an open-ended commitment to local authorities, which is precisely what the Bill will do, is entirely unacceptable. If the Government want to press forward with that policy, they are entitled to do so and to justify that. However, surely they should at least restrict the total contribution that must be made by local authorities, so that they can budget sensibly, as the Government rightly suggest they must.
	There are other implications. The UK Home Care Association has raised concerns that the measure will put downward pressure on prices paid to independent sector providers, which provide 81 per cent. of publically funded home care, and that home care will be seen as a low-cost option compared with residential care. There is a danger that we would see a further deterioration in wages in the home care sector as a result of local authority pressure. There is already a huge turnover of staff in the care home sector-the rate is nearly a quarter. That is not good for the kind of care for older people that we would like.
	The message from the home care sector-this is from UKHCA's very good briefing-is simply that
	"there are no more pips to squeak"
	out of it to meet that kind of shortfall. If the hon. Member for Eddisbury (Mr. O'Brien) pressed amendment 48 to a Division, the Liberal Democrats would support him. We all accept that we are in a difficult time of recession, but should the Government say, "We expect that large contribution of £250 million from local authorities, but we are not going to expect more"? Simply put, it seems that the sums in the impact assessment cannot be relied on, and therefore, if the measure goes through, local authorities can expect it to cost them significantly more than the Government's estimate.

Phil Hope: Amendment 15 would effectively exclude local authorities from the duty to provide free personal care to people living at home on the ground of a lack of central funds. That cannot be acceptable. Local authorities have a duty to meet the eligible needs of their clients. They may take their available funds into account when deciding the level of resources allocated to social care for adults, but they may not refuse to meet a person's eligible needs on financial grounds.
	It is true that, currently, councils may charge for non-residential services. When doing so, they should employ a means test to help them determine the charges to be recovered. However, it is right that the provision of personal care to those with the highest needs living at home, which will enable them to continue living at home, should be exempt from such charges. It is also right that local councils play their part in the provision of personal care to those living at home with very high needs as a way of supporting their local communities. I hope that alongside the measures in the Bill, councils continue to develop their universally available preventive services for those in their local communities. Such services offer local authorities the chance to invest in prevention and reablement now to prevent higher care costs in future.
	I draw Members' attention to "Use of Resources in Adult Social Care", a comprehensive assessment of the ways that local councils make best use of those resources, which the Department published in October 2009. It enables a comparison between councils on their performance regarding how they go about using their resources. Councils can look at a number of examples of excellent practice, and find ways to deliver higher quality services at a lower cost. I highly recommend the document. Indeed, hon. Members might want to sit down and discuss it with their local authorities to ensure that the best practice we see in certain parts of the country is repeated in others, and indeed across the whole country.
	An integral part of the Bill is the proposed offer of reablement. That is a package of intensive support measures to help somebody to become more independent and to continue to live in their own home. As the document to which I referred and others tell us, the development of reablement services is already under way in many areas. We are providing some £420 million of funding in the first year of implementation, to help councils both expand that best practice and meet the costs of providing free personal care to those who are eligible.
	I should like to place on record my rebuttal of the work of fiction on Department of Health research funding that the hon. Member for Eddisbury (Mr. O'Brien) repeated at the Dispatch Box a moment or two ago. Let me assure him and the Committee that cancer and dementia funding will not be affected in the way he described. We are providing more funding than ever for health research-a £1 billion budget is ring-fenced for research. We are committed to this: we are not cutting funding for cancer research to fund free personal care, as we have made clear. Indeed, our research budget has doubled since 1997.
	Our social care proposals will be funded in part by making efficiency savings on Department budgets that are outside the ring-fenced NHS research and development budget. Those efficiencies will therefore not affect vital front-line projects in areas such as cancer and dementia. The research budget that funds the National Institute for Health Research and the Department's policy research programme will increase to more than £1 billion in 2010-2011. I hope I have put our position clearly on the record.
	Amendment 48 would allow the Secretary of State to make regulations to put a cap on the amount of personal care that local authorities may be required to provide to people living at home. Although local authorities can use cost ceilings as a guide when deciding on the best and most cost effective way to meet a person's care needs, they have a duty to meet those needs regardless of costs, and they cannot use such cost ceilings rigidly. As such, the amendment would be inappropriate-it would enable the Secretary of State to make regulations that would impose a blanket requirement on local authorities to restrict their provision of vital personal care services to people living at home to a particular amount, which could result in unmet needs.
	Let me be clear on the accusations about the impact assessment and the robustness of our figures. We have not underestimated any hourly rates for buying the care: we are using the figure of £15.75 per hour at 2011-12 prices, which is well within the expected costs. In addition, we have not underestimated the number of hours of care needed, as some have alleged: we have used the average number of hours based on Personal Social Services Research Unit modelling for people with highest needs-that is to fund the personal care element of an individual, not all the services for those who meet the criteria. We are now consulting on three possible approaches to a distribution formula, which will make allocations as fair as possible. Some authorities might have higher costs, but others, where there are fewer people, will fund their own care locally. We propose to review the workings and the costings of the scheme within the first 18 to 24 months.
	I know that things have been said by other organisations and I am pleased to have had the opportunity to put on the record here in the Chamber our view that our costings and funding assessments are robust. I therefore ask the hon. Member for Eddisbury to withdraw the amendment.

Stephen O'Brien: I am very glad that the Minister felt able to seek to rebut the criticisms of his calculations and workings, not least on the impact assessment, by simply stating them at the Dispatch Box. That is precisely what I was able to do about the various highly spurious fictions and assertions that he used to criticise the Conservatives' home protection scheme. We are equal now that we have corrected one another.
	Clearly, the amendments were probing. I am sorry that the hon. Member for Leeds, North-West (Greg Mulholland) feels that we should press amendment 48 to a Division, and I am grateful that he indicated that he would have supported us had we done so, but there is a risk that that would be irresponsible, because the cost implications of the amendment are unclear, and we must all operate under very severe constraints in the current conditions.
	Most importantly was the Minister's placing on record the absence of a diminution of funds for research. That statement will be looked at carefully by a number of organisations that have been in touch with us about such matters. He will be aware that that has been an issue. It is important that people should have the confidence of knowing that we can match our research effort, and the sustainability of that effort, to the profile of disease and demographics that we can see coming down the track, rather than looking at things on a purely historical basis. We fully support the increase in the efforts being made, which we advocated well in advance of the Government's decision to increase the funding for, and the emphasis on, dementia research for instance. The costings discussion has been helpful. On that basis, I can confirm that our amendments were probing amendments, so I beg to ask leave to withdraw the amendment.
	 Amendment, by leave, withdrawn.

Stephen O'Brien: I beg to move amendment 31, page 1, line 20, at end insert-
	'(4BA) The Secretary of State shall report annually to Parliament the compatibility of any new regulations and guidance relating to the provision of personal care to a person living at home with the European Convention on Human Rights.'.

The First Deputy Chairman: With this it will be convenient to discuss the following: amendment 27, page 2, line 16, at end insert-
	'(6A) The Secretary of State shall report annually to Parliament-
	(a) the costs of delivering personal care at home in that year;
	(b) the estimated costs of delivering personal care at home in future years.'.
	Amendment 45, page 2, line 16, at end insert-
	'(6A) The Secretary of State shall report annually to Parliament-
	(a) the number of people receiving personal care at home under the terms of the Act in that year in every local authority area in England;
	(b) the cost of providing personal care at home under the terms of the Act in that year in every local authority area in England.'.

Stephen O'Brien: Amendments 31 and 27 stand in my name, while the Liberal Democrats spokesman, the hon. Member for Leeds, North-West (Greg Mulholland), will no doubt speak to his amendment 45.
	This is an important group of amendments, and the Minister will understand why. Amendment 31 seeks for a report to be presented to Parliament on the human rights compatibility of the Bill, reflecting the apparently shaky legal ground that the Government are on. Amendment 27 seeks a similar report into costs. To some degree, my anxiety to press that amendment to a vote might have been ameliorated by the Minister's most recent comments, in his response to the previous group of amendments, about the fact that there would be a review of the costs, including the members' costs and so forth, at quite a fine-grained level over, I think he said, 18 months or two years. That is obviously important in ensuring fairness in the system, as well as the clarity that will be needed.
	That said, uniquely, the impact assessment looks at costs for only two and a half years, so if we did not have a review within 18 months or two years, we would get pretty short shrift. The impact assessments that this Government have produced with Bills have habitually looked at costs over a 10-year period, so to get only two and a half years on a policy area covering such obviously long-term projections as this one does seems mighty unusual, if not a touch opportunistic. The costings are therefore somewhat shaky to say the least. I was therefore pleased that the Minister was able to set out at least some clarifications, corrections and admissions of error in his letter to the shadow Health Secretary, my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), on 8 January.
	Amendment 45, standing in the name of the Liberal Democrats, seeks a report on the numbers. It is amazing to find out that the Government have very little of the hard data on which their policy is based.
	On amendment 31, the Bill comes with a lengthy justification, by comparison with other Bills, of its rectitude in the face of the Human Rights Act 1998. Its length should alert the Committee to the Government's nimble footwork in the face of their own legislation. The Government's problem is that the Human Rights Act prevents discrimination on the basis of residence. The Secretary of State and the Minister's argument is that such discrimination is allowed in certain cases and that the Government have the latitude to discriminate in that way. So much for us all being equal under the law. It was that very discrimination that my right hon. Friend the Member for Charnwood (Mr. Dorrell) sought to highlight in one of his earliest contributions today. I therefore hope that he will have the opportunity that he was looking for to discuss the issue in our debate on this group of amendments.
	I am pleased that the Joint Committee on Human Rights is looking into the matter. I hope that that process will be concluded before the Bill goes to the other place, because it really needs to be. Through you, Mrs. Heal, I hope that some urgings might be made in the right direction, in order to speed up the Joint Committee's work, because of the speed with which we are considering the Bill in this House-I dare say that the Government will wish to push for the same in the other place-and because there is already an absence of the accompanying guidelines and regulations, either in draft form or actually published, that are so important for the Bill. The fact that we do not have the Joint Committee's report in advance, as is normally expected, makes us worried that an attempt could be being made-I put it no more strongly than that-at a sleight of hand.

Stephen Dorrell: My hon. Friend has had the benefit of reading some papers that I have not read. Did I hear him right? Was he really saying that although there is a general prohibition on discrimination on the grounds of residence in the European convention on human rights, the Government's position is that it does not apply to Governments and that Governments are allowed to exercise such a discretion on the grounds of residence that others are not allowed to exercise?

Stephen O'Brien: I will expand slightly on that point as I proceed, because it is a bit fine-grained and quite technical. However, in essence, his concern is confirmed, I am sad to say, in that there is effectively a get-out in such circumstances, by and behalf of Governments. That is highly challengeable, and therefore causes me concern; hence our amendment, which would require a report. The Committee would welcome that, given the importance that the whole House attaches to what appears on the front of Bills, namely a certificate, as required under the Human Rights Act, from the Secretary of State in presenting a Bill on First Reading to assure the House that it is compliant with the European convention on human rights. This Bill carries such a certificate, from the current Secretary of State.
	Given the numerous legal loopholes in the Bill, the Committee will be interested to know that, according to the Minister in a parliamentary answer to me:
	"No external legal advice was sought on this matter."-[ Official Report, 8 December 2009; Vol. 502, c. 293W.]
	We know that the Government are concerned, and not just because of the extraordinary length and somewhat defensive nature of the note in the explanatory memorandum, to which my right hon. Friend might find it helpful to refer. That concern is now being picked up elsewhere, not least by a commission by which the Government have set great store-indeed, they brought it into existence precisely to look into such questions. The Equality and Human Rights Commission has expressed concern that
	"this proposal appears to cut across the options set out in the Government's Social Care Green Paper."
	The commission also says:
	"Care must be taken to avoid creating negative trade-offs for other people still with considerable needs trying to access care at home. For instance, if the proposal actually further reduces the sums available to help those with less critical needs, but who could benefit substantially, including helping them to retain work or remain socially active, it may just serve to increase those whose needs more rapidly become critical."
	The Equality and Human Rights Commission said that in its briefing that arrived only at lunchtime today. I hope that that is regarded as useful information for the Committee to consider.
	I hope that the Minister will take this opportunity to confirm that the strength of any defence in a court of law would depend on the purpose of the Bill. In the compliance statement, the purpose of the Bill is about
	"enabling, supporting and encouraging more people to avoid or delay entering residential accommodation".
	The Government claim that that is a "legitimate aim" for the purposes of the European convention on human rights. However, according to the impact assessment, the purpose of the Bill is about
	"Funding care to those in need at the time of their need,"
	which is also what the Prime Minister said at his party conference. Is that a "legitimate aim" for the purposes of the Human Rights Act? The record will no doubt show the Minister's response, which will undoubtedly be prayed in aid by highly paid human rights lawyers. I dare say that he will have taken a lot of advice before making his prepared remarks.
	The Government's defence is also that the proposal is a "proportionate" measure, which goes some way to answering my right hon. Friend's question. What is the legal status of that defence, given that the Bill has such a small benefit for costs-if any, as has been accepted-that, according to the impact assessment, it has little overall effect on public sector manpower and public expenditure, and that it helps no more than 5 per cent. of the so-called at-risk population?
	The Committee will be interested to know that there is no statutory definition of the word "home", although it appears in a number of statutes, such as the Housing Act 1985. That was the Act that legislated for the right to buy, a right that has seen people gain property, as well as the social mobility attached to that, only to have to sell it to pay for their long-term care. Part of the problem that we are now facing is with precisely that generation. The 1985 Act speaks of a person's "only or principal home". There have been many cases concerning the definition of that phrase. I will not take up too much of the Committee's time, but hon. Members should be aware of the succession of cases on that issue, which include Crawley Borough Council  v. Sawyer in 1988, Ujima Housing Association  v. Ansah in 1998, Amoah  v. Barking and Dagenham in 2001, which will be of interest, and Hammersmith and Fulham  v. Clarke in 2001.
	That is an important succession of cases, because many of them link home with the intention of the resident to occupy it rather than with the occupation itself-so intent appears to be what the law relies upon. What happens in law if an individual is able to define the care home in which they reside as their home? The money resolution, as we know, if not the legislation per se, would make provision for the funding of that person's care. By proving that a residential care home is their home, could an individual make themselves eligible for free personal care?
	If the Minister does not have a ready answer, he can be fairly sure that the courts will seek to provide one in the due light of day if the Bill becomes an Act. I hope he will take this opportunity to guarantee that the Bill will not be open to legal challenge on human rights grounds. Is he confident enough to commit the Government to funding the full costs of any successful legal challenge on those grounds? Moreover, will he place the internal legal advice in the Library, given the germane points that have now been raised as a result of great concern, not least admitted by the fact that the explanatory memorandum has had to go to such lengths without the decisiveness of a conclusion that one would normally look for with such an important matter as supporting a Secretary of State's certificate on the front of a Bill?
	This is not merely a case of lawyers dancing on the head of a pin, which some might argue is the closest to angels they will ever get. Professor Malcolm Johnson of the university of Bath has said that for people with high needs-those requiring care for more than 30 hours a week and typically dementia patients-more complete, appropriate and cost-effective care can be delivered in a care home. That is backed up, according to the noble Lords Joffe and Lipsey in the other place, not least by the Personal Social Services Research Unit-known as PSSRU-and the London School of Economics, which is doing the costings for the Government's social care models.
	In a response to me of 8 December, the Minister said that residential care would remain an "appropriate setting" in which to meet some people's care needs. If, because of financial concerns, the measure keeps people at home who really ought to be in residential care, it could be seriously detrimental to the mental and physical health of many frail people. That is why all the third parties are arrayed against piecemeal reform in this area. To some degree, there has been a certain circularity in the arguments over previous groups of amendments, not least in discussions with the hon. Member for South Thanet (Dr. Ladyman).
	Amendment 27 deals with costings. I repeat my rather lukewarm welcome, given the Minister's assertions at the end of the debate on the previous amendment grouping, but it is important to state from the outset and on the record that this care is not free. Someone must pay for it: in the short term that will be the beneficiaries of public health campaigns, and, it has been argued, the taxpayer and Cancer Research in the long term. We heard the rebuttals that the Minister sought to pray in aid at the end of the previous grouping, so we must take them as they were put forward, but someone somewhere has to pay. The proper phrase that should be used is "free of charge", but I dare say that that would spoil the slogan on the Prime Minister's already printed election leaflet.
	As we have said, the Secretary of State has rejected taxpayer funding for social care reform, but the Prime Minister thinks it is a good idea. It is right to have some public services, like our NHS, that are free of charge, but we should never forget that they are not completely free. Indeed, it was the current Secretary of State himself who recommended that patients be given an indicative receipt for the cost of their care. I am sure that the Minister is more than well aware of the record of when the Secretary of State said just that when he was a Minister. The problem with Labour Members is that they continue to think of taxpayers' money as Government money. Increasingly, with their party facing financial as well as, one hopes, electoral bankruptcy, we should be concerned that they do not look to taxpayers' money as some form of re-election fund.
	The Government have estimated the cost of the measure at £670 million a year. "Estimated" is the right word. Table 2 is dependent on figures drawn from the unpublished modelling for the Green Paper, and the full model remains unpublished. The model used to estimate the flows in and out of residential care has not been published. The model referred to in paragraphs 5.12, 5.13 and annex B of the impact assessment is still under development. This is also the model on which estimates of savings are predicated. According to paragraph 4.6, the costs of the whole policy are still being modelled and the assumptions are going to be tested through consultation with stakeholders, which runs until 23 February. We have already discussed that point about the timetabling.
	The number of individuals who are FACS-critical critical is estimated from a secondary analysis of data from the English Longitudinal Study of Ageing-an analysis that has not yet been published. Little is known about the number of younger adults who fund their own home care. The figure of 110,000 should be "treated as an estimate", as I was told in a written answer.
	The estimate of people for whom reablement is successful is based on the experience of a single local authority, West Berkshire. The Minister has told me in another written answer that the Department does not hold equivalent data for other councils. Perhaps he would like to spell out the reasons why the Government feel that West Berkshire is representative of Britain as a whole.
	The estimate of home care spend in annex B of the impact assessment is an estimate plucked out of the air, for which the Minister has given no justification, while the estimate of the costs of reablement are also plucked out of the air. When I asked the Minister what the minimum and maximum costs of reablement were, he replied that he understood that there was a "wide variability" in "different councils" and that the "derivation" of a cost of £1,000 was "clearly stated" in annex B of the impact assessment. What does annex B say? It says:
	"It has been estimated that reablement costs £1000 a person (roughly 30 hours of reablement at £30 an hour)",
	but we have no sources for where either of those figures referring to the number 30 came from, so we have to ask whether these have just been made up. The costings assume that only 10 per cent. of the people who currently go into residential care will instead stay in their home to receive free personal care. Is that really tenable-that faced with the choice of paying £25,000 a year in a care home, or free care in their own home, only one in 10 will take up the free option?
	The Government have persistently refused to extrapolate their calculations beyond 2012, so we have had to do it ourselves. Using just a linear projection, the costs will double to about £1.2 billion a year by the end of the next decade. The excuse given to me in a parliamentary answers was:
	"We cannot reasonably make these extrapolations because of the levels of uncertainty",
	including
	"the unknown detail of any future national care service and the unknown future economic climate"-[ Official Report, 16 December 2009; Vol. 502, c. 1323W.]
	The Minister also mentioned an uncertainty that aspects of people's behaviour would change as a result of the "introduction of these proposals", and that the policy would be reviewed after 12 to 18 months to "ensure" that there are "no perverse incentives". This is a funny way of doing policy: to set the hare running and if it all goes wrong, we will revisit it-a kind of microcosm of the last 12 years, one might suggest.
	Such uncertainties are eye-watering. For example, if all the people with informal care switch, this adds £17 million to the cost. If the Government have underestimated the number of younger adults with needs by just 10,000 across the country, it adds £6 million. If care inflation rises faster than general inflation-at 4 per cent., for example-this would add £14 million. An arbitrary underestimate of the numbers of elderly people of just 1 per cent. adds an extra £5 million. The assumption that the relationship between care need and cost is linear-in annex A-turns out to be wrong. Again, a 1 per cent. deviation equals £6 million extra. If all these costs were realised, it would cost an extra £49 million a year. If the Bill provides a perverse incentive for care homes to redesign themselves as "extra care"-we have had some discussion about that-and that happened, it would add an extra £1 billion to the cost. Even if only 10 per cent. did so, it would still be another £100 million.
	My estimates are, perhaps naturally, pretty conservative. The noble Lords Lipsey and Joffe, in their supplementary memorandum to the Green Paper, were highly critical of this measure, noting that the costs in Scotland inflated by 74 per cent.-that was equivalent to an extra £500 million in the first year. Leaving aside the potential costs of the measure, given that people will not receive transport, meals, cleaning, shopping, sitting services and so forth free of charge, will the Minister tell us the likely range of spend on such services for an individual receiving what the Government are now proclaiming as free care? On that basis, I support amendments 31 and 27, and point out that we may well wish to divide the Committee.

Stephen Dorrell: I congratulate my hon. Friend the Member for Eddisbury (Mr. O'Brien) on tabling the amendments and again on the way in which he spoke to them. Both amendments are hugely important.
	Amendment 31 deals with the European convention on human rights. My hon. Friend should be specifically congratulated on reminding the Committee that the modern world is increasingly one in which the untrammelled right of law-makers to make laws that seem like a good idea on their way to the party conference podium is qualified by a series of commitments that Governments have entered into over the years to ensure that the laws of this country comply with certain basic principles. For our present purpose, the principles are set out in the European convention on human rights. According to one of them-acknowledged in the explanatory notes-it is not consistent with the convention, and therefore with good law, to discriminate between individuals on the basis of where they live. First, the Government acknowledge that that is a principle of good law because it is in the convention, to which this country is a signatory. Secondly, the explanatory notes explicitly recognise that an individual in residential care
	"might allege that they are being discriminated against in the protection of their rights under Article 14 ECHR".
	This is not something dreamt up by my hon. Friend; it is something that the Government recognise as a potential weakness in the Bill.
	What is the Government's defence? According to the explanatory notes,
	"the Department's view is that the different treatment"-
	Members should note that it is acknowledged to be different treatment-
	"of people living at home is not discriminatory. This is because the policy underlying the different treatment pursues a legitimate aim in a proportionate way."
	I do not follow those two sentences. The explanatory notes state that the Department's view is that the different treatment is not discriminatory, and then state that it is discriminatory, but that the discrimination is justified
	"because the policy underlying the different treatment pursues a legitimate aim in a proportionate way."
	Having acknowledged that the treatment is discriminatory, the Government then say that the discrimination, despite being contrary to the ECHR, is justified because in the Department's view, or more precisely the view of the Prime Minister-I do not believe for a moment that the policy had its origins in the Department-
	"the different treatment pursues a legitimate aim in a proportionate way."
	Let us consider what is the "legitimate aim", and whether it is, in truth, proportionate. According to paragraph 23 of the explanatory notes:
	"The key aim...is to enable, support and encourage more people to avoid or delay entering residential accommodation."
	That is set out as the objective of the policy. Let us now consider how effective, according to the impact assessment, that policy will be. According to the assessment, the Government believe that 2,000 of the 277,000 people affected will switch from residential care to care at home as a result of a policy whose purpose is
	"to enable, support and encourage more people to avoid or delay entering residential accommodation."
	The Government's proposition is that they want to delay people's entry into residential care. Their own assessment of the effectiveness of that policy is that it will stop 2,000 people entering residential care. The question for the Committee and, I suppose, ultimately for the European Court is whether the Department is right in saying that that is proportionate.
	What the Department is doing is violating rights under article 14. The Government cannot argue that they are not violating those rights. Indeed, they have acknowledged that they are doing so, but claim that that is justified by the policy objective, which they describe as proportionate. When the policy objective is measured for its effectiveness, it is shown to involve 2,000 people. The rights of all the other people in residential care-there used to be roughly 500,000, and I would guess that the figure is still the same-are being violated. Those people are being discriminated against so that 2,000 people-according to the Government's own assessment-can be prevented from entering residential care.
	I invite the Committee to reflect on whether the defence of the policy set out in the explanatory notes stands up. My hon. Friend has already given his assessment of the two pages in which the Government have set out their position, which might be described as "Methinks they do protest too much." The Government have acknowledged a violation of rights, and have justified it on the grounds of the delivery of a specific policy-the policy being that 2,000 people's care arrangements will be changed, but the rights of 500,000 will be violated so that those 2,000 can benefit from the Government's policy change.

John Redwood: Does my right hon. Friend believe there is a serious chance that the legislation will be struck down under the provision in the European convention?

Stephen Dorrell: My right hon. Friend and I are not the only ones who think that there is a serious argument to be answered. The Government clearly share that view. I invite him to assess exhibit A: the explanatory notes, in which the Government have devoted two pages of typescript to explaining why they are safe under this exposure.
	Let me now deal with the second amendment. The two are linked. As I have already pointed out, in assessing the principle of proportionality we must first assess the 2,000 people against the 500,000. We must then assess the 2,000 against the £500 million that is being spent on meeting this policy objective. Is the Bill proportionate, given that it has assessed 500,000 people against 2,000? Is it proportionate when it is recognised that the public spending cost of the Prime Minister's commitment to achieving the change in care arrangements for 2,000 people is, according to the Government's own estimate, £500 million?
	I do not believe that the Government have delivered their estimate of cost beyond the two-and-a-half year horizon. As my hon. Friend the Member for Eddisbury pointed out, if we look beyond that horizon, the £500 million will increase geometrically when the behavioural consequences of the measure are taken into account. According to Lord Lipsey's analysis of behavioural change and its financial consequences, the policy will result in a public spending cost well north of £1 billion. I invite the Committee to consider again whether that is a proportionate way in which to deliver the policy objective of enabling, supporting and encouraging
	"more people to avoid or delay entering residential accommodation",
	given the Government's belief that 2,000 people will be affected.
	Enlarging on the spending element, my hon. Friend was right to observe that apart from the principle of article 14 of the ECHR, there is the further question of affordability, value for money and the policy assessment of that £1 billion expenditure. We should bear in mind not just the general financial environment with which everyone is familiar, but the fact that the context of the Green Paper that the Government presented last July was correctly recognised to be the demand pressure, and therefore the spending pressure, that is already building in this sector, reflecting rising demand for social care, and rising expectations about the standard at which that care will be delivered to the next generation of elderly people.
	That is why my hon. Friend is entirely right to ask for a proper statement of the Bill's financial consequences looking beyond the current two-and-a-half-year horizon. We should remember, of course, that the projection by Derek Wanless did not confine itself to two and a half years, but looked forward to 2020. If my memory serves me well, he envisaged the cost of social care rising from 1.2 to 2 per cent. of GDP over that period-in other words, a marginal, additional cost merely to maintain the current level of social care delivery of 0.8 per cent. of GDP. My hon. Friend will probably remember better than I the current size of GDP, but such a percentage must equate to about £20 billion-and merely to maintain the current delivery of social care.
	Despite the words in the Green Paper and the weasel words of the Minister from the Dispatch Box when he tried to evade the point, the Government are encouraging people to believe that the underlying rising demand for social care cannot be met on the basis that it all be paid for by the taxpayer. The Government are now half promising, however, that the taxpayer will meet the bill, which will further constrain our ability to deliver on the rising amount and quality of care that we all want.

Stephen Ladyman: I was not going to comment, but I will now because the right hon. Gentleman has gone into party political matters. Is it not a little strange for him to pray in aid Wanless and talk about the rising costs over 20 years of social care, given that the solution proposed by Wanless-a reform of attendance allowance -is the one policy that those on his Front Bench oppose?

Stephen Dorrell: Wanless proposed a variety of different funding mechanisms, but the truth is that neither major party has leapt to pick up the main Wanless proposal. We had a debate on that, prompted by the Government's Green Paper, to which I contributed. I said that the debate had come far too late and that we should have had it 10 years ago, as the Prime Minister at the time had promised. None of that, however, alters the fact that we are now committed down a policy line that half promises precisely the policy option that Wanless ruled out, that the Government ruled out, that the hon. Member for South Thanet (Dr. Ladyman) to his credit has again ruled out, that my party has ruled out and that even the Liberal Democrats have now ruled out-that it all be loaded on to the taxpayer. That is an unsustainable option. The Government have always recognised that it is unsustainable, but they are now half promising to take that route. No wonder they will not publish a projection that shows how much it will cost.

Greg Mulholland: I shall try to keep my comments brief because I am conscious that time is running out, and I am keen to get through the rest of the amendments if possible.
	I want to speak to Liberal Democrat amendment 45, but I will also comment on amendment 27. The amendments follow on succinctly from the last set of amendments and relate again to the concerns about the costs of the Bill and the fact that not only is there a real lack of faith in the costs set out in the impact assessment-many organisations have expressed that concern-but that there is a potential burden on local authorities. It would be sensible, therefore, to have in the Bill a method of reporting to Parliament on the costs.
	It is a shame that we did not discuss that matter with the hon. Member for Eddisbury (Mr. O'Brien) before, because the best amendment we could have tabled might have included subsection (a) and (b) of our amendment 45 and (b)-as subsection (c)-of his amendment 27. Having the estimated costs in future years is a good suggestion. It would also be incredibly sensible to have the annual reporting done according to every local authority area, given the burden placed on local authorities that we discussed earlier.
	To get to that stage, it would also be incredibly helpful-I hope that the Minister accepts that this suggestion is intended to be helpful-to look at the number of people claiming free personal care at home under the terms of the Bill. That would be sensible because it would allow the Government to identify where there is a particular need and which local authorities in England have a larger proportion of people eligible-particularly a larger proportion of older people. Where there are certain demographics, and where local authorities will be particularly burdened, it would be helpful, for those local authorities and Parliament, to have such a report.
	I do not know whether the hon. Gentleman intends to press amendments 31 or 27-or both-to a Division, but we would certainly support amendment 27. I think that our amendment is slightly clearer, but given that he gets the chance to press his, and we cannot press ours at this point, we would support him.

Phil Hope: I shall address the issues presented through the amendments. First, let me be clear on amendment 31 concerning the European convention on human rights. The Bill has been deemed compatible with the ECHR. The memorandum, which is detailed and quite thorough, was criticised for being too long, but I think that doing it well and thoroughly means that we get it right. Guidance has been sent to the Chair of the Joint Committee on Human Rights, and I have the joint memorandum with me.
	Hon. Members are right to draw attention to what I think is a well-argued case that the grounds for the different treatment of people living in their own home are clear. The key thrust of the policy behind the Bill
	"is to enable, support and encourage more people to avoid or delay entering residential accommodation."
	As such, the policy pursues a legitimate aim and one that goes back across different Governments. The policy will achieve that aim in a proportionate way because it is aimed at those with the highest need-the group of people most at risk of having to enter residential accommodation and who therefore have the most to gain from taking advantage of the provision of free personal care in their own homes. The Department's view is clear: the policy behind the Bill is not discriminatory. That is clearly laid out in the measures.
	I might add that we are already seeking to ensure that any secondary legislation and guidance is compatible with the convention, and that the regulations that the Secretary of State will be empowered to make under the Bill and related guidance will be no different in that regard.

Stephen Dorrell: Will the Minister confirm that the Government's own impact assessment states that the number of people who will switch from residential care-in other words, who reflect the achievement of the policy for which the derogation from the ECHR is effectively being sought-is 2,000?

Phil Hope: The key thrust of the Bill
	"is to enable, support and encourage more people to avoid or delay entering residential accommodation."
	The right hon. Gentleman has rightly described one particular group of beneficiaries-those people who might switch. I understand that that is in the impact assessment. However, there is another much wider group of people whom we will help to avoid or delay entering residential accommodation.

Stephen Dorrell: If that is the argument on which the Government will rely, why did they not set it out in the impact assessment?

Phil Hope: I think that everything has been set out. I have set it out here. It has been set out in the memorandum sent by the Department of Health to the Joint Committee on Human Rights.

Stephen Dorrell: I am grateful to the Minister for his patience. That is exactly my point. It was not set out in the impact assessment, but was rushed out of the Box to give the Minister something to say. If that is the basis on which the Government are relying, why was it not in the impact assessment?

Phil Hope: Nothing has been rushed out from the Box. One might argue that it could have been, but no doubt there was confidence in my abilities to answer these questions fully and thoroughly by referring directly to the statement that we put to the Joint Committee on Human Rights. I think I have put that matter to rest. Amendment 31 calls for an annual report on compatibility, but that is an unnecessary requirement because the Bill is compatible.
	Amendments 27 and 45 would require the Secretary of State to report to Parliament annually on the costs of providing free personal care at home, the estimated costs of that in future years, and the number of people who receive personal care in each local area. The hon. Member for Eddisbury (Mr. O'Brien) made a number of detailed points about the impact assessment. He repeated a number of the answers I had given to him via written questions, and he went on to make a series of interesting extrapolations, because the impact assessment is in place for only two and a half years. I want to reiterate a point I have made to him on the Floor of the House and in writing: the impact assessment covers only the period from October 2010 to the end of 2012-13. Estimating beyond that point is problematic because of the uncertainties involved. As I said in respect of previous amendments, the proposals in this Bill are a step towards having a fully integrated national care service, at which point a different set of assumptions will need to be applied, and therefore the hon. Gentleman's extrapolations will not apply.
	I also want to emphasise to the Committee-the hon. Gentleman acknowledged this in moving the amendment-that we have committed to reviewing the implementation of free personal care within the first 12 to 18 months of the policy coming into force. After that review, it will be possible to reconsider the predicted costs of delivering free personal care and the conditions for eligibility, if necessary.
	If the costings for the first year prove to be accurate, it would be an unnecessary burden on local authorities for them to have to produce data to enable the Secretary of State to report to Parliament annually on this matter. Such a report would require a greatly increased volume of data collection by local authorities, which I think both Government and Opposition are keen not to impose. There will obviously need to be some increase in the amount of data collected by councils in order that the delivery of free personal care can be accurately considered, and we are consulting on what data would be needed and how the extra data might best be collected so that the extra pressure on local authorities is minimised-an aspiration that I think both Government and Opposition would support.
	On the basis of my responses, I ask the hon. Gentleman to withdraw his amendment.

Stephen O'Brien: This is a very important group of amendments, because we have been discussing the preparedness of the Government-their having a thorough understanding of the technical detail in advance of laying this before the House. In respect of seeking a derogation from compliance, under the Human Rights Act 1998, to the European convention on human rights, the Government have yet to convince us. Therefore, we will seek to divide the Committee, not least because of all the arguments of reinforcement put forward by my right hon. Friend the Member for Charnwood (Mr. Dorrell), who is a former Secretary of State, and also because the Minister did not give a sufficiently robust answer on the cost-benefit question-on the argument about just 2,000 people benefiting from this, weighed against any increase in access.

Tom Clarke: Only at the end of the debate was reference made to the cost of the bureaucratic set-up for local authorities. Has the hon. Gentleman consulted local authorities about the labyrinthine implications of contributing to an annual report? Would the money not be better spent on the needs we have identified?

Stephen O'Brien: As the Minister has said, additional data collection of some nature will have to be done. The scale of that will have to be measured against the need to make sure it is efficient. However, the blunt truth is that local authorities have been consulting us, and expressing their anxiety and concern about the drafting of the Bill.
	However, we wish to divide the House on amendment 31 on human rights convention compliance. The Government have not made a good enough case. It is very important that we test the opinion of the Committee, not least because all of us as legislators have a fundamental duty to get this specific aspect of the Bill right, and we want to give the many experts in the other place the opportunity to discuss it, and we also want them to see that all the arguments have been fully aired. The Government have such a weak case that we need to record our concern. That is why I shall press the amendment to a Division.

Question put, That the amendment be made.
	 The Committee divided: Ayes 197, Noes 287.

Question accordingly negatived.

Stephen O'Brien: I beg to move amendment 17, page 1, line 21, leave out from beginning to end of line 2 on page 2.

Michael Lord: With this it will be convenient to discuss the following: amendment 18, page 2, line 1, leave out 'undergoing' and insert 'undertaking to undergo'.
	Amendment 19, page 2, line 1, leave out 'a' and insert 'at least one'.
	Amendment 20, page 2, line 2, at end insert-
	'(4CA) Any process under subsection (4C) may not be contingent on the activity of, or acquiring, a carer.'.
	Amendment 21, page 2, line 2, at end insert-
	'(4CA) The process under subsection (4C) shall be available to any person with care needs according to guidance issued under section 7(1) of the Local Authority Social Services Act 1970.'.
	Amendment 43, page 2, line 4, at end insert-
	'(4E) Provision by virtue of subsection (4B) may for the purposes of this section not require the recipient of care to undergo the process defined in subsection (4C) if, in the assessment of a registered medical practitioner, the life expectancy of the person is such that the process will be limited or no benefit, or detrimental to the health of the patient, or will not alter their care needs.
	(4F) Provision by virtue of subsection (4B) may for the purposes of this section not require the recipient of care to undergo the process defined in subsection (4C) if, in the assessment of a registered practitioner, the process will be of limited or no benefit, or detrimental to the health of the patient, or will not alter their care needs.'.

Stephen O'Brien: Amendment 17 would remove new subsection (4C) and amendment 18 would change the word "undergoing" to something that we think will improve matters. I shall have explained where the Committee's opinion may best be tested by the time I conclude my remarks.
	The Committee will see that, once again, the Government are falling over themselves in the drafting of this clause. Bad drafting is of course indicative of bad legislation, and the circumlocutions in this provision are a mark of the Government's political motives, which we have already discussed. How would a lawyer define, for instance, a
	"process designed to maximise the person's ability to live independently"?
	Marriage would seem an obvious example of such a process, but I cannot imagine for a second that we will have local authorities mandating that. This is, of course, a legislative reference to reablement. I am not convinced, in truth, that reablement needs to be on the face of the Bill. It does not need legislation to make it work, of course, and surely that should be the test of access to the statute book.
	More worryingly, the way that the Bill is drafted means that it does not allow a local authority to refuse to provide care until the reablement process has occurred. For example, let us say that Mrs. X has suspected critical needs. She applies for an assessment, which takes three weeks-that is not unusual. She is told that she needs reablement, specifically a stair lift and a walk-in bath, which might normally take a further month to purchase and install-let us hope so. It is January, and the council's budgets are tight, so it slows down the process in the knowledge that it does not have to start funding her until the reablement has, in the terms of the proposed new subsection, been undergone. Mrs. X has three months without the care that she needs. That is a legally enforceable event under the Bill as drafted, hence my criticism.
	Will the Minister confirm whether the Bill would take precedence over section 47 of the National Health Service and Community Care Act 1990, notably subsection 1(b), which states that a local authority must make a decision as soon as an assessment is carried out, and subsection 5, which does not
	"prevent a local authority from temporarily providing or arranging for the provision of community care services for any person without carrying out a prior assessment"?
	The Minister has confirmed in answer to a parliamentary question that
	"there are uncertainties about the long-term impact of re-ablement on the need for care, we cannot make an accurate forecast at this current time."-[ Official Report, 14 December 2009; Vol. 502, c. 764W.]
	So much for evidence-based policy. Amendment 18 is the amendment that the Committee might want to see tested.
	Amendment 19 asks how many rounds of reablement people will get. In a response to a parliamentary question, the Minister said:
	"There are currently no proposals to restrict packages of re-ablement."
	He went on to say, however:
	"It will be for councils to determine who might benefit from this intervention and whether it is appropriate to repeat this at a later date."-[ Official Report, 8 December 2009; Vol. 502, c. 291W.]
	Does that mean that the Government will fund reablement that goes outside the indicative grants to local authorities?
	Amendment 20 would prevent reablement from including an informal carer. Will the Minister confirm that reablement will never include an obligation on a family member to take up informal caring responsibilities? Returning to the question of personal care, it seems that carers will continue to be taken into account in the assessment of whether someone has critical needs. The Government's estimate is that only 50 per cent. of carers for people with critical needs and only 5 per cent. of carers for people with moderate needs will give up that informal care when they see that if they do that, care will be provided free of charge. Do such small figures hold water when it comes to the points made by my right hon. Friend the Member for Charnwood (Mr. Dorrell) earlier?

Stephen Ladyman: My reading of this amendment is slightly different to that of the hon. Gentleman. Will he help me? Proposed subsection (4C)-the bit of the clause that is removed-states that a local authority "may" make this measure conditional. It does not say that it has to do so. I read it as a mechanism by which a local authority may-if it feels that, by getting somebody to undergo an intensive period of support, that person might have a lower care need that would have to be funded by the state and the local authority, or if it feels that making the person accept certain technologies in their home and making them use them would ensure a lower cost of ongoing care-insist on the person having that level of support. In other words, it is a way of ensuring that somebody does not avoid doing something that would reduce the local authority's costs in the long term just because they are too lazy or too wilful to do it.

Stephen O'Brien: The hon. Gentleman is obviously carefully thinking through the way in which this will operate, and I respect that. The difficulty is that this provision is the trigger mechanism. I am concerned that there should not be any chance for the trigger to be delayed by the actions of local authorities if they postpone the time at which reablement is, in the word proposed by the legislation-it is not my word at all-"undergone". I am seeking to ensure that local authorities cannot delay because of the words used in the legislation. That is what we are here for, after all. I want to replace "undergoing" with "undertaking to undergo" in order to make it clear that it should start at the point at which an assessment is incepted. I hope that our amendment makes that a lot clearer and a lot more certain. I hope that that helps the hon. Gentleman.

Stephen Ladyman: The hon. Gentleman's aim is laudable, and I can understand it, but if a local authority were to delay providing support for somebody on the basis that it had not done something or made something available, surely no court would allow the local authority to get away with that. The ombudsman certainly would not.

Stephen O'Brien: That might well be the case if the person for whom care and support was needed was the cause of the delay. I suspect that that would cause some of the support that would otherwise be given free of charge not to be available anyway, because the person would not be ready to accept that level of care. The issue is the provision of care and what starts the requirement, under law, to make that care, which will be free of charge, available. That is what we have been concerned about. There is an ambiguity, to say the least, and probably an uncertainty, in the way in which the legislation is drafted. I do not think that this amendment is hugely challenging or controversial. It is, I hope, trying to give the Government's intent a better chance of being borne out in how the wording leads to decision-making behaviour from the people who will interpret the Bill in an administrative or legal capacity rather than necessarily any behaviour from those who are looking to receive the care.
	Amendment 21 is a probing amendment to ask the Minister to clarify who will be eligible for such care, and amendment 43, tabled by the Liberal Democrats, who will address the points that it raises, is on the question of palliative care. I am in sympathy with it and supportive of it. The regulatory impact assessment says that people receiving palliative care would be excluded from reablement. That seems quite harsh. As Help the Hospices has said,
	"people can receive palliative care alongside curative treatment (it's certainly not an either/or) and people can also receive palliative care for prolonged periods of time (for some, such as younger people with life limiting conditions, such care can go on for many years)".
	I shall ensure that the Liberal Democrats have the chance to develop that point, but I think that it is important that we recognise it. It is a powerful point and we are grateful that they have tabled that amendment.
	The Minister stated in an answer to a parliamentary question on the number of cases in which people received palliative care that he had no idea what the median, mean and maximum life spans are for people receiving palliative care. I hope that he will be able to expand on the answer that he gave me on 7 December. That issue, in itself, will be of concern.
	In conclusion, as I want to keep the introduction to these amendments relatively brief, I think that the technical way to do this will be formally to suggest that although I will be happy, with leave, to withdraw the lead amendment in this group, I hope to have the opportunity to push amendment 18 to a vote and to test the opinion of the Committee on it, unless we hear some staggering response from the Minister, which is not expected.

The Second Deputy Chairman: I am grateful to the hon. Gentleman for making that point, but we will return to it when we have finished the debate.

Phil Hope: I want to respond to the debate-I am disappointed that nobody else wanted to contribute-

Greg Mulholland: rose-

The Second Deputy Chairman: Order. Does the hon. Gentleman wish to contribute?

Greg Mulholland: Yes.

The Second Deputy Chairman: With the greatest of respect, I am not a mind reader. Hon. Members must rise in their seats if they wish to contribute.

Greg Mulholland: Thank you, Sir Michael. I think that I was as confused as you were by the lack of anybody who wanted to discuss the amendment.
	I want to speak briefly about amendment 18, which the hon. Member for Eddisbury (Mr. O'Brien) wants to press to a vote. We would clearly all support the reablement process in principle, but it has to be done in a way that reassures people that it has not been done unnecessarily and that it is not going to be a burden to people. If it is pressed to a vote, we might need to support it, but we will wait to hear the Minister's comments.
	Amendment 43 is designed to protect people for whom a medical professional thinks that reablement would not be appropriate. That group would include the terminally ill or anyone on whom the process might have a detrimental effect. The idea behind the amendment is that, although we support the idea of reablement, it must not be possible for a local authority to refuse someone free personal care at home on the ground that that person refuses to undergo a process of reablement if a qualified medical practitioner has said that the process could realistically do more harm than good. We have to acknowledge that, given the huge cost implications for local authorities, there is a possibility that they might seek to push people into undergoing reablement, or repeat reablement, and that they might threaten to withdraw services if an individual refuses to reply.
	The amendment would give the option of an exemption for those people who, for good reason, feel unable to take part in the reablement process, particularly those who are in possession of a doctor's note or another form of recognised medical advice recommending that that would not be suitable. Making people go through that process could cause them great anxiety or even physical harm. We believe that the measure should be a vital part of the reablement process if we are to have confidence in it, and I reserve the right to push the amendment to a vote at the appropriate time if I do not hear a satisfactory response from the Minister.

Stephen Ladyman: The hon. Gentleman's amendment gives the impression that any letter signed by a GP and giving the effect he has described would mean that a local authority could not insist on a reablement process going ahead. As we all have examples in our constituencies of GPs who are prepared to sign virtually anything that their patients ask them to sign, what right of appeal would a local authority have, under his amendment, to challenge such a situation and say that reablement would be an appropriate course of action?

Greg Mulholland: That is a fair point; clearly, such a mechanism would need to be built in. There are sometimes concerns about the use of doctors' notes, but that issue needs to be addressed separately rather than being allowed to turn this idea on its head. We should not say that the exemption should not be there because of other concerns. We tabled the amendment to raise the principle for discussion. It is then for the Government to consider how best to build such an exemption into the system. I shall wait to hear the Minister's response.

Phil Hope: This is an important group of amendments. The policy that underlies the measures in the Bill has two clear strands-free personal care for those with the highest needs who live in their own homes, and a package of intensive support or reablement to help people to remain at home for longer. Reablement services are offered by some councils, but it is important that local authorities across the country continue to develop and improve those preventive services. We know that with a six-week package of appropriate reablement measures many people would be able to reduce their dependency on care services and therefore live more independently. It will not always be appropriate for someone to undergo a period of intensive support, depending on their individual circumstances. That is why we think that local authorities should be given the discretion to make that judgment and to provide a reablement package as a precursor to arranging a package of personal care for the individual where that is thought to be necessary. I want to make it clear that, as my hon. Friend the Member for South Thanet (Dr. Ladyman) rightly said, the measures give local authorities permission to choose to operate in that way.
	On the worry that the hon. Member for Eddisbury (Mr. O'Brien) described, and the example he gave, the immediate needs of individuals would be met while they were undergoing reablement. A more detailed assessment would then be undertaken once reablement was completed. The detailed work on the scheme would not be included in the Bill but would be a matter for guidance, drawing on professional expertise and the views of various stakeholders. Removing such an express power by accepting amendment 17 would, I fear, do nothing to encourage local authorities to develop further their reablement services. It would also fail to encourage investment in services that help people to improve their personal situation and help to prevent it from deteriorating and their care needs increasing. That is one crucial reason why I urge him to withdraw that amendment.
	Amendment 18 would similarly fail to encourage individuals-I think this is the point that my hon. Friend the Member for South Thanet was making-to make the best use of the reablement services available to them. The amendment would mean that a local authority could make free personal care conditional not on an individual undergoing reablement, but merely on undertaking to do so. In other words-this is an important point, and my hon. Friend was right about this-individuals would not need actively to undertake reablement to receive free personal care, but would need merely to undertake to local authorities that they would do so. Therefore, that reablement might never take place.
	Effective reablement relies upon sensible and effective decision making by local authorities, by people who need care services and by their care partners. Reablement packages need to be put in place and need to be undertaken to assist people in living their lives fully and in reducing their dependence. The amendment could result in a reduction in partnership working between the individuals who need care and their local authority. It could also result in authorities beginning to work up reablement packages that the relevant individuals have no intention of taking up. The amendment would not have the effects that we would wish to see of ensuring that people access and use reablement packages as a critical part of the whole system of improving care for people and, indeed, providing free care for the people with the highest greatests needs.
	Amendment 19 would change the description of one of the potential eligibility criteria that may be set out in regulations. It would change the words
	"a process designed to maximise the person's ability to live independently"
	to
	"at least one process designed to maximise the person's ability to live independently".
	That process, which is described in new subsection (4C), is more commonly referred to as reablement. Details of what might be included in a package of reablement will be laid out in regulations or in guidance. We intend for the process to be a single process, but it could involve a range of interventions and support such as home adaptations, the installation of telecare and sessions with an occupational therapist or physiotherapist. There is a risk that, if the amendment were accepted, local authorities could use the wording "at least one" to delay giving people the free personal care that they need indefinitely. Clearly, that is not the intention underlying the Bill.
	The effective and appropriate use of reablement services can help individuals to reduce their dependency on care services and can increase their ability to live independently at home. However, where an individual still has high personal care needs following reablement, they should receive the support they need to meet those personal care needs. That is why we ask that amendment 19 be withdrawn.
	Amendment 20 addresses the issue of carers. It would insert the wording:
	"Any process under subsection (4C) may not be contingent on the activity of, or acquiring, a carer."
	The amendment does not make clear the extent to which carer activity, which is what it describes, would be excluded. Would knowledge and expertise be excluded, or only direct help with day-to-day living? If the amendment seeks to exclude carer involvement when reablement packages are designed, that could lead to a reduction in partnership working, which we all agree is vital, between the local authority and the carer. That could result in a diminished outcome for the individual who uses the services. We all know that the role that carers play is absolutely vital, because they often have invaluable knowledge about the care requirements of the person for whom they are caring. Those requirements need to be taken into account when a reablement package is designed.
	Even in a situation where carers would still be able to input their knowledge and expertise to design reablement packages, it would be difficult for them to be assured that that was being carried out appropriately if they were not involved in the reablement activity, where they wished to be.
	Carers' involvement in reablement is crucial, when that is beneficial to the individual being cared for. They have an invaluable role in supporting the people for whom they care, and in working with local authorities and care providers.
	I emphasise that the Bill does not seek to place additional burdens on carers, but neither does it seek to exclude them from working with councils to achieve the best outcomes for the people for whom they care. Therefore, we believe that it is important that local authorities continue to work with carers on behalf of those with the highest needs who are eligible for free personal care at home. Given my explanation of the clause, I ask the hon. Member for Eddisbury to withdraw the amendment.
	Amendment 21 purports to extend the potential for local authorities to offer reablement to all those with care needs under the guidance issued under section 7 of the Local Authority Social Services Act 1970. The concern, apparently, is that the guidance should set out how the care is to be made available, and how needs are to be assessed. However, local authorities are already required to act under the general guidance of the Secretary of State in discharging their social services functions as set out in the 1970 Act. That includes guidance covering the principles of assessment and the commissioning of services.
	The details of reablement services will be set out in guidance, but the services are designed to help people maximise their skills for living more independently. We all know that they are a valuable part of helping people to live at home for longer. Local authorities are free to offer reablement to anyone whom they feel may benefit. Amendment 21 potentially restricts local authorities' provision of reablement services only to those who have existing care needs. I think that that would go against the very important trend towards universal and preventive services.
	Amendment 43 would prevent regulations from authorising local authorities to make reablement a condition of free personal care in certain circumstances, namely when a "registered medical practitioner" or other "registered practitioner" thinks that the process will be of
	"limited or no benefit, or detrimental to the health of the patient, or will not alter their care needs."
	I hope that the hon. Member for Leeds, North-West (Greg Mulholland), who speaks for the Liberal Democrats, agrees with me that local authorities are best placed to decide whether a package of reablement would be beneficial before an individual receives personal care support free of charge.
	It is obviously important that local authorities do not force people to undertake a reablement package unnecessarily. We expect councils, when they are deciding whether reablement is appropriate, to consider in a sensitive fashion the overall benefit and impact of such a package, and to work with the patient's family, GP and others to assess that person's suitability for reablement. That may be particularly important when a person is undergoing palliative or end-of-life care.
	I know that one of the concerns about the Bill is that reablement will not be available for those undergoing palliative care. I can assure the Committee that, where councils believe that reablement might benefit a person undergoing palliative care, they may offer it. However, if the person is unlikely to benefit, he or she should not be forced to undergo reablement merely to qualify for free personal care. All the detail of that will be covered in guidance.
	Ultimately, local authorities assess people's care needs and their eligibility for care and support, so it is right that they should be able to make decisions about the services that might be appropriate, in conjunction with other relevant partners in care.

Greg Mulholland: I thank the Minister for that explanation, in which he has made it clear that the Government's intention is that people should not be pressed into undergoing reablement. As long as that is the case, I shall not seek to divide the Committee on amendment 43.

Phil Hope: I am grateful to the hon. Gentleman for that response. I think that it is right that local authorities should be able to make decisions about which services are appropriate, but they must do so in conjunction with other relevant care partners.
	I thank hon. Members for raising these issues to do with reablement. I have spoken at length because it is important that the whole Committee understands our intent and how the proposal will operate. All the details will be addressed more fully in the guidance accompanying the regulations, and I hope that what I have said will persuade the hon. Member for Eddisbury to withdraw his amendment.

Stephen O'Brien: I am grateful to the Minister, who sought to address a number of issues that we raised in relation to this group of amendments. I note that on his amendment, the spokesman for the Liberal Democrats, the hon. Member for Leeds, North-West (Greg Mulholland) expressed himself relatively satisfied with the Minister's approach.
	I indicated earlier in my remarks that the amendment on which we should test the opinion of the Committee was not 17, which happens to lead the group.
	I intend to press amendment 18 to a Division, but I will say whatever I have to say at the right moment, to make sure that that is clear.

The Second Deputy Chairman: Order. When the hon. Gentleman has completed his remarks, we will deal with the mechanics. He can trust the Chair to do that, I think.

Stephen O'Brien: I am clear, Sir Michael, that I can, thankfully, trust the Chair to do just that.
	It is important to ensure clarity because the reablement process is, as the Minister made clear, in the hands of and, in many ways, in the gift of the local authority, the providers. In the provision of wheelchairs, for example, people may fall between various providers. I am anxious about the trigger mechanism that gives people their expectation and their entitlement, at a time when they are very vulnerable and need the greatest possible certainty, together with their carers who, as the Minister rightly said, will continue to be part of the process.
	It would be useful to register our concern that the word "undergoing" is not sufficiently clear in the present drafting, and press the amendment to a Division, not least so that anyone reading our proceedings with care in another place will be able to make sure that the trigger mechanism is properly analysed. I beg to ask leave to withdraw the amendment.
	 Amendment, by leave, withdrawn.
	 Amendment proposed: 18, page 2, line 1, leave out 'undergoing' and insert 'undertaking to undergo'.- (Mr.  Stephen  O'Brien.)

Question put, That the amendment be made.
	 The Committee divided: Ayes 183, Noes 285.

Question accordingly negatived.
	 Clause 1 ordered to stand part of the Bill.

Clause 2
	 — 
	Extent and short title

Stephen O'Brien: I beg to move amendment 42, page 2, line 27, at end insert-
	'(1A) The provisions of this Act come into force on whatever day the Secretary of State appoints by order made by statutory instrument.'.
	The amendment would quite simply enable the Secretary of State to appoint the day on which the Act would come into force. It might be the same day that it receives Royal Assent, as I assume is the intention, or it might be another day. Will the commencement sections or other sections of the amended existing legislation require the Secretary of State to set out commencement provisions for the measures in the Bill? Can the Bill commence before the regulations in clause 1(4) are passed? That harks back to some of the other points that we have made about the rapidity with which we are having to consider the Bill without some of the necessary supporting documents, research and basis.
	It is worth pointing out that this is the only piece of primary legislation sponsored by the Department since 1997 that includes no commencement provision, which reflects on the nature and provenance of the Bill. The reason for the amendment is that I wish to cause the Secretary of State and the Minister to pause for thought when it comes to putting it into action. I hope that just for a moment, they will contemplate what a mess has been occasioned by the desperation of a Prime Minister anxious to use the final moments of a Government and a Parliament to rush through legislation that appears to have been electorally driven.
	We have looked as best we can at the Bill to scrutinise it carefully in the very limited time that we have had available. An important point is that we were up against the incredible tightness with which the money resolution was framed, which understandably and rightly excluded many amendments that we wanted to table. Many people outside this place wanted them tabled, because they have a great need to understand how the system will operate in practice and they need clarity and certainty. We are dealing not only with people who care but with people who have care needs, and there is no substitute for the clarity and the security that it occasions for people in that circumstance.
	As Labour Members have made clear, and as the Minister has made clear in answers to me, the Government have assessed the funding only for two and a half years. We have had some discussion about that. That suggests that although the Bill is an interim measure, which is at odds with the fundamental point that it is meant to be consistent with the Green Paper, it has turned out to be something of a spatchcock of legislation squeezed into the end of this Parliament.
	I am keen not to detain the Committee, because we have put on record many times our view about the litany of broken promises, from the then Prime Minister Tony Blair promising in 1997 to sort out social care all the way to today, 13 years later. I hope that the Minister will take the chance provided by the amendment to contemplate what many people have said about the Bill, which is that it has driven a coach and horses through the Green Paper process. I know that he resists that view, but it seems real among those who take the closest possible interest in these matters. Niall Dickson of the King's Fund, and shortly to be of the General Medical Council, said in response to the Prime Minister's announcement of the policy:
	"The problem is these latest proposals seem to have been hastily put together and appear to cut across the options set out in the government's own Green Paper. After all, the government has only just finished consulting us on the very different proposals set out in that document."
	The English Community Care Association said that
	"it is unhelpful to have just one piece of the jigsaw".
	The Association of British Insurers noted:
	"It is regrettable that the Personal Care at Home Bill undermines the Government's own Social Care Green Paper",
	and the Equality and Human Rights Commission expressed the concerns that I set out when discussing the previous group of amendments. Lord Lipsey, who was famously a member of the royal commission on long-term care and is usually no enemy of the current Government, put it most clearly when he said:
	"What has gone wrong is that in the middle of the consultation...the Prime Minister has declared"
	this Government policy.
	The reason for this amendment is to give those hon. Members with a keen interest in how the Bill has been put together a chance to talk of their regret about how it has been done, not necessarily its objectives. Many of us agree with its objectives; the trouble is that it does not sit well in the context that we have all been working towards and the attempt to build a consensus. I hope that the Minister will come to recognise that there is a price to pay for political tribalism, given his reluctance to contemplate the merits of our home protection scheme. Taken together with the provisions in the Bill and other measures urged on me by the hon. Member for South Thanet (Dr. Ladyman) among others, that scheme could provide the whole picture, rather than just one piece of the jigsaw. That is why we have tabled the amendment. We do not want to see a postponement of implementation, but this Bill should be seen as part of a consensual process, as far as we can achieve that. In the absence of such a process, and with the Government taking such a tribal approach, we have had difficulty scrutinising the legislation. Its provenance is more electoral and party political than policy driven. The amendment would give the Government chance to pause and contemplate the fact that they should have set the Bill in a broader context. I invite those who think that it could have been handled better-perhaps as Lord Lipsey has suggested-to support the amendment.

Phil Hope: The reluctance of the Opposition to support this Bill was obvious on Second Reading and today. The amendment would require a commencement order before the Bill could come into force, and would be yet another obstacle to the provision of free personal care for those adults and older people with some of the highest needs. We want to help those people live independently in their own homes.
	The hon. Gentleman talks about consensus. He holds out the hand of consensus, but in his other hand is the back-stabbing knife of the Conservatives' disgraceful and scaremongering petition on disability benefits for older people. That shows the two-faced attitude of the Opposition in applauding the Green Paper at the same time as opposing the Bill. It is discourteous when the Conservatives are running a petition on their website that seeks to scare vulnerable and anxious older people with assertions about disability and attendance allowances that are wholly untrue.
	Although the Conservatives have been reluctant to support the Bill-describing it as anomalous and perverse, as they have done today-other people have welcomed it unreservedly. Imelda Redmond, chief executive of Carers UK, has said:
	"Many families face crippling costs to pay for care, and this historic pledge to end the means test for those with the highest need could make a huge difference to their lives."
	That is in stark contrast to the quotes cited by the hon. Gentleman.

Stephen Dorrell: rose-

Phil Hope: I will give way in one moment, but I was thrown quotes criticising the Bill, and I am going to throw back some quotes from stakeholders who support it.
	The president of the Association of Directors of Adult Social Services, Jenny Owen, said of the Green Paper and the Bill:
	"Today's announcement is an important and valued first step on that road",
	meaning the road to creating a national care service. Mike Padgham, chairman of UKHCA, said:
	"We welcome the Prime Minister's high-level commitment to homecare and look forward to the detail of how people will be able to access free personal care. Home-based care is an excellent service which keeps many people out of hospital and...enables people to return to their communities quickly following hospital discharge."

Stephen Dorrell: The Minister has said several times that the Bill concentrates money on those with the greatest care need. Is that true? The resources are in fact being channelled to those with the greatest care needs that can be met at home, but those with the greatest care needs are those whose needs cannot be met at home. Their needs must be met in residential care, and for them the means-tested system will continue to operate.

Phil Hope: We go around the same arguments that we have been having all afternoon. The right hon. Gentleman fails to acknowledge the importance of supporting people independently in their homes, which I thought all parties accepted. The people with the highest needs are the people to whom we have given priority, as a step along the road to a national care service that will meet the needs of all older people-indeed, all adults over the age of 18-over the years to come. His party recognises that that is a huge challenge, and we are endeavouring to propose measures for it.

Stephen Dorrell: I am grateful to the Minister for his patience in giving way, but he again spoke about people with the highest care needs. We all agree that we should encourage as many people as possible to live at home and introduce a system to enable that-there is no argument about that. However, it is simply untrue that the Bill focuses resources on those with the highest care needs. Those who need residential care have the highest care needs, but the Bill does nothing for them.

Phil Hope: The right hon. Gentleman simply continues to dig himself into a bigger hole. The question before the House is this: do we support a Bill that will help those people living at home with the highest care needs-yes or no? To Labour Members, the answer is clear and unequivocal, but the Opposition have continually put forward obstacles, objections and amendments, and describe the Bill as perverse and anomalous.
	As the Bill continues through Parliament, I will be clear in telling my constituents how proud I am that over 10 years, we have been developing and improving care services in this country. The Bill is one more step along the road to creating a comprehensive solution to the care needs of the people of this country. Amendment 42 would simply put another barrier in the way and we do not need it. No separate commencement order is needed and no other obstacle or hurdle is required: they would simply add more work and time to the process in general.
	We do not intend the regulations to come into force within two months of Royal Assent, and that is acceptable. It is time for the games to stop and for the Conservatives to give the Bill unalloyed and clear support.

Stephen O'Brien: This is slightly depressing. The Government have chosen to discuss what they regard as a prime ministerial flagship Bill for only one day on the Floor of the House. The Bill was put together at short notice and flies in the face of the processes that the Government had already set up through a Green Paper. All sorts of people outside this place, including those who give a lot of their time to caring for vulnerable people and the many people in the various categories of need, have grave concerns about it. There is a big question mark about the legitimacy of the Bill. We have properly asked questions about its compliance with the European convention on human rights and my right hon. Friend the Member for Charnwood (Mr. Dorrell) rightly identified and reinforced those discrimination issues in his argument. However, after all that, we end up with the Minister somewhat charmlessly deciding that it is really rather an insult to subject the legislation that he is meant to be defending to scrutiny. Of course, the only way in which one can do that is by way of amendment-I dare say that that would be clear in the minds of most hon. Members. The fact that the Bill has been rushed out and is contrary to the run of the Green Paper means that many questions have to be asked.
	In my introduction I simply proposed my amendment 42 and said how it is framed, so it hardly warranted the Minister's quite extraordinary rant. It is framed to allow the Committee an opportunity to test whether it feels that the process by which the Bill has come about, the time in which the consultation will take place-it will not finish until February-and the results of the assessment of that consultation, which will be important for so many people representing various stakeholder and constituency interests, have been sufficiently thought through and well framed for us to produce good legislation, which we can pass from this House to the other place to look at. We have set up a number of things that I hope those in the other place will find useful, as hooks for their discussions, so that their expertise can be brought to bear.
	I hope that the record will show that, far from not being supporters of the Bill, we are indeed supporters of the Bill. We are also keen to ensure that it works for the purposes that it is intended to work and for the people for whom it is meant to work. That is why we have done what we had to do in this Committee stage. That is precisely why we are all sent here: to do our legislative duty. I am surprised that the Minister found that insulting and felt that it warranted his outrageous rant, which I thought was undignified and not worthy of the office that he is privileged to hold.
	Therefore it is vital that we give the Government and the Secretary of State a chance to pause for thought. Has this Bill been sufficiently well framed, in its timing and for the process by which we are drawn to this place to scrutinise legislation? Is it sufficient for a Government simply to say, "We want it to happen; therefore it will happen"? Or, at this late stage in this Parliament, should we be doing our duty, by looking at the constituency that the Bill is meant to represent? The Minister has not given an adequate answer to why 2,000 people becoming net beneficiaries is a sufficient benefit, as opposed to the costs, to warrant the £500 million being pledged, not least because money is to be scraped from savings by local authorities-local authorities are meant to be serious providers; they are also meant to have the opportunity to save-from budgets that are often already pared down to the bone.
	It behoves us to give the Committee an opportunity to express its opinion. Had the Minister chosen to take a slightly different route in responding to this debate, we might have been more amenable to building a consensual approach, but that does not seem to be on offer. The Committee should have the opportunity to register its distaste at how the Government have sought to treat us in dealing with the amendment and at the Minister's response. I therefore seek to press the amendment to a vote.

Question put, That the amendment be made.
	 The Committee divided: Ayes 188, Noes 286.

Question accordingly negatived.
	 Proceedings interrupted (Order, 14 December).
	 The Chairman put forthwith the Question necessary for the disposal of the business to be concluded at that time ( Standing  Order No. 83D) .
	 Clause 2 ordered to stand part of the Bill.
	 The Deputy Speaker resumed the Chair.
	 Bill reported, without amendment.
	 Third Reading

Phil Hope: I beg to move, That the Bill be now read the Third time.
	This is a small Bill containing just one substantial clause, but, as has been remarked, it will have a great significance for thousands of the most vulnerable adults and older people in our constituencies. As was said, we know that social care needs a radical overhaul, and the Green Paper published last year reflects our commitment to taking decisive action. However, the promise of fundamental reform in the future must not prevent us from taking important measures here and now to help those with the greatest need living in their own homes.
	The Bill means we can take action to reduce the unfairness and uncertainty that many people feel as their health worsens and their care needs grow. The Bill will provide support and financial relief to 400,000 older people with the greatest care needs, including those with conditions such as Parkinson's, dementia and motor neurone disease. Some 280,000 people who require high levels of intimate personal care on a day-to-day basis will now get these services for free in their own home. Many of them have faced the burden of paying large amounts of money for care as their conditions deteriorate, and this Bill will remove that millstone. In addition, a further 130,000 people will receive free reablement or rehabilitation to help them to recover their independence after a fall, bereavement or serious illness.
	The Bill is practical and will be financially manageable for councils. Indeed, many local authorities already offer some form of reablement support, which is helping them to use their resources more efficiently. Because of that, we have a running start on many of the financial and logistical hurdles that were discussed in Committee, including recruiting and paying for the additional work force required to honour the commitment. We are consulting widely on how the system will work and how people will be assessed. I want councils to have flexibility over how they resource the free personal care offer, while we ensure consistency across the country over who receives it.
	Above all, the Bill supports a simple principle-one that I must have reiterated in every intervention on the right hon. Member for Charnwood (Mr. Dorrell)-which is that we must do everything we can to help people to live as well as they can, for as long as they can and in their own homes. That is what people tell us they want and why the Bill focuses on providing personal care for those who live in their own home, including sheltered or supported accommodation. Let us remember that the Bill will not only benefit older people but support their family members, many of whom face the difficult task of looking after an elderly relative while also bringing up their own family and holding down a job. It will bring wider economic and social benefits for carers, as well as long-term savings for the taxpayer by preventing hospital admissions and reducing care costs down the line. In other words, the Bill makes sense financially, as well as morally.
	Social care is changing across the country thanks to the £500 million that we have put into the transforming adult social care programme. Today's Bill is another big step forward and a vital bridge to the radical proposals for funding social care heralded in our recent Green Paper. This is a significant moment for the House. By passing this Bill, we can extend the promise of a fairer, more affordable and more sustainable care system in the future, and we can make an immediate difference, here and now, to our most vulnerable constituents, giving a hand up to those laid low by age and illness. I commend the Bill to the House.

Stephen O'Brien: H.G. Wells famously once said:
	"In England we have come to rely upon a comfortable time-lag of fifty years or a century intervening between the perception that something ought to be done and a serious attempt to do it."
	Perhaps that is a little harsh, but we all remember Tony Blair's pledge at the 1997 Labour party conference that he would sort out social care, and yet now, nearing 13 years later, the Government are still dealing with only a relatively small part of the overall picture, of the demand that has been coming from all quarters for many years.
	Broadly, we have had a good series of discussions this afternoon. Time constraints have, however, been placed on us by the Government's somewhat bizarre programming decisions. This is not a free-vote issue, and nor is it a matter of national security, so it is puzzling that we have been given only this brief opportunity of one day to cover all the remaining stages of the Bill on the Floor of the House, rather than having the fuller scrutiny it would have received with a longer Committee stage upstairs and potentially a full Report stage. Frankly, we have ended up little, if any, closer to the clarity we need on some issues, such as the true costs of this measure-not only the basis for many of the estimates, but the costs post-2012 and the potential costs if the estimates are wrong. We expressed sufficient doubts to raise some serious questions about that. The Government have given little hope to local council tax payers and service users, who are set to bear the brunt of any funding shortfall.
	The potential legal loopholes in the Bill are very worrying for the added costs they would bring, such as in respect of care homes restructuring, residential care qualifying as "home", and, of course, the human rights implications of the measure, which we have rightly discussed at length. A number of questions remain about reablement: who will get it, whether it is carer-dependent, and whether the costings are accurate and who will pay if they are not. Most disturbingly, the Government have refused to budge on their position regarding people with palliative care needs, although the discussion we had on that gives us some grounds for optimism that the situation may improve.
	The proportionality of this legislation remains in serious doubt. The benefit estimated-that word again-by the Government is only £190 million a year, less than a third of the cost. The measure impacts on only 279,000 people, of whom 166,000 already receive care for free. It makes a difference to only 110,635, fewer than 2.5 per cent. of what the Government have said are the 6 million people in England with care needs.
	The Bill makes no attempt to allow the whole gamut of social care to be addressed in the future. The Government have our home protection scheme before them. They have made various criticisms, but none of them amounts to anything other than the usual political rhetoric. As we have made clear, that scheme only addresses residential care, but their policy addresses some very narrowly defined domiciliary care. One could seek to put those two together and build a more consensual approach to trying to plug all the gaps and address the whole waterfront, as it were, of social care. In that, one can see the prospect of an opportunity for an approach that is a little less adversarial than, sadly, we have experienced, particularly in terms of the last group of amendments, which was a shame.
	The Government have done little to reassure us that they know the meaning of the word "free" in terms of public policy: "free" means that somebody else pays. In this instance, they are pledging to cut money. A number of budgets have been mentioned, and they have sought to give rebuttals. We will study very carefully the rebuttal put forward at the Dispatch Box on research budgets, such as those targeting diseases such as dementia and cancer. There has also been a pledge to cut some money from the NHS IT programme. As Ministers are aware, I have been ferreting around, using parliamentary questions to try to get some answers, but the Government have never come clean about what contractual break clauses there are in NHS IT, or in some other contracts to do with the supply of swine flue vaccine, which I know my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the shadow Secretary of State, looks forward to receiving in terms.
	It was important to make sure it is recognised that the Government have not pledged to support this policy with money from the centre, other than some proportion of it. They are also relying on the efficiency savings they simply announce can be made from local government-a full quarter of a billion pounds.
	Of course, I wish that the Government had taken the opportunity to look beyond the narrow confines of this particularly electorally inspired Bill, whose provenance was the Prime Minister's comments at the time of his Labour party conference last September. With the money resolution being as tight as it is, there was not the opportunity for them to undertake full and proper consideration, not least of our home protection scheme. We would have enjoyed having the opportunity to debate and propose that. However, that is how it is, and we recognise that it will be difficult to persuade this Government to do what we hope they will do, which is to bring together a number of us to try to find some way to deliver on the very legacy that the Secretary of State claims he is trying to secure.
	The Secretary of State says that he seeks some "unstoppable momentum for legislation" in this area. It is impossible to know now whether the Bill will complete all its stages, given that it must go through the upper House and that we have no idea when the general election, which must come before June, will be called. Thus we cannot be sure whether this Bill is "unstoppable" or whether it represents "momentum"-we are not even sure that it will be legislation. What we do know is that establishing unstoppable momentum requires a degree of consensus. If the Government genuinely wish to take that approach, I would be more than happy to be asked to participate in such a discussion, as I dare say those from other Opposition parties would.
	As the measure goes strongly against what the Government set out in their Green Paper, we have faced the difficulty of trying to understand how to place the Bill in the context of the wider reform that so many of us seek and know must be addressed-our political generation has no option but to do that. In our consideration of this Bill in the time available to us, we have faced particular difficulty in understanding the true evidence that lies behind it and the calculations of the costs. A lot of us, including many outside this place, have had desperate concerns about the thoroughness and robustness of the impact assessment, even when the Government have sought to reissue some of the numbers. None the less, we have tried to give the Bill reasonable scrutiny.
	Interestingly, the Bill may face its biggest difficulty when it goes to another place. The Government may well have a tougher time of it there, where they have some noble "Friends"-I assume that that word still applies-in Lord Warner and Lord Lipsey who have certainly, in comments to date, been squaring up for something of a fight on this. Lord Lipsey has called the Bill a "gimmick" and said that it is
	"bad policy but also a very bad way to do policy just to find a...highlight for your Labour Party conference speech."
	Who knows, perhaps everything has changed in Lord Lipsey's mind after the apparently rousing call to arms by the "Mr. I'm a team player" Prime Minister at the parliamentary Labour party meeting last night-we will wait and see.
	In advance of what might be considered in the other place, what matters is that we have done our very best to try to unearth what truly lies behind this Bill and how it will in fact be made to work, given that it is proclaimed to service the needs of some-only some, not all-of the most vulnerable in our country. I am grateful not only to you, Mr. Deputy Speaker, and to all those who have assisted us in going through the process of scrutinising this Bill, but particularly to my many Conservative colleagues who have taken the opportunity to contribute to this extremely well-informed and responsibly discussed debate on an important matter.

Stephen Ladyman: For a relatively small group of people across the country who are struggling at home with a high level of care need and who are worried about the cost of that and whether they can continue to live in their own home or will have to go into residential care, this Bill will transform their lives. We need to put things in context, as I have attempted to do all the way through these debates, by saying that that group is relatively small. That is why this Bill, despite being good and worthy of support, is only the next step in the reform of social care. It is not the first such step and it is important to emphasise that over the past 12 and a bit years many advances have been made in the provision of social care. One that the Opposition continually fail to mention is the fact that if someone goes into care and does not want to sell the family home that they have lived in, local authorities now have the money to put a charge on that home to pay the social care debts after that person's death. The reason why so many people still sell their family home against their will is that Conservative councils and, I have to say, Liberal Democrat councils all around the country forget to tell people about that benefit that is now available.
	That is not the only social care reform. Extensive efforts have been made to upgrade the status of the social care work force, to qualify them, to ensure that the regulation of social care is fit for purpose and to ensure that appropriate training is available to people who work in social care. Measures have been taken to improve the methods of discharging people from hospitals so that there is no longer bed blocking and to ensure that social care provision is available for people in the community when they need to be discharged from hospital. Reablement schemes are available around the country and improvements have been made to the provision of services and to the integration of services between the NHS and social care. Efforts are also being made to extend the availability of telecare and of extra care accommodation. I remain disappointed by some of the comments made by the Opposition about extra care. If, as they say, they are approaching this Bill in an open-minded spirit and if they want to approach me, I will happily take them to see some extra care accommodation and to see the benefits that such care can provide to people.
	All the measures that have been put in place so far have been the first steps in improving social care provision in this country, but the Bill that we are discussing today is only the next step on that path. The biggest step of all remains in front of us: we need to fold all those measures together into the comprehensive social care package that we know we have to face up to. In my view, it will necessitate some form of co-payment and some method of bringing in extra resources from the population. I said on Second Reading that my preference would be a hypothecated inheritance tax, and I shall continue to reiterate that until somebody takes the idea seriously. Whether we use that solution or some other insurance-based solution, a solution will have to be found. We must find a solution to how we can get local councils to assess people's care to ensure that packages are portable and to agree on how they will be funded so that they are funded to the same level around the country. That will have major implications for localism and the role of local authorities in the future.
	These are huge issues that will have to be addressed-and addressed they must be-but this Bill is nevertheless a valuable contribution to that process. It will radically transform the lives of that group of people with high levels of care needs who want to stay in their own homes. For that reason, this Bill is absolutely worthy of the House's support, but only with the caveat that we should all commit ourselves to taking the next step as soon as possible.

Norman Lamb: It is a pleasure to follow the hon. Member for South Thanet (Dr. Ladyman). I absolutely agree with his last point: we must all commit ourselves to finding a sustainable, long-term solution that meets the needs of all those with care needs and not just the small group whom this Bill addresses.
	Let me start by making it clear that there are two other points on which we all agree. I am sure that we all agree on the absolute importance of the idea that any reform should facilitate people's remaining in their own homes for as long as they can. For the group of people who will benefit from the Bill, that will clearly be the case. We must ensure that that principle is at the heart of the final reform that we achieve.
	The second absolutely important principle, which this Bill addresses, is the value of reablement. The Bill recognises that at present we do not do reablement well enough. There are patches of good practice around the country where authorities have been able to demonstrate the enormous potential savings and, more importantly, the dramatic improvement in people's lives of committing properly to reablement. However, in too many parts of the country reablement is not provided well enough. At its best, the Bill provides an incentive to the system to ensure that reablement takes place. That is a good thing.
	Following the debates today and on Second Reading we still have three core concerns, the first of which is affordability and sustainability, particularly given the trend towards an ageing population. We used to be attacked by the Government for our previous commitment to free personal care. Two years ago, we removed that commitment. I took a paper through our party conference, because I reached the conclusion that one could not, in reality, argue the case for free personal care given the demographic changes that we are witnessing. The Green Paper recognises that point, but the Bill shifts in that direction. That causes me real concern, because the cost of the duty to provide free care to the relevant group of people will keep rising.
	The Government have set a cap on the amount that they will contribute, so the other potentially pernicious impact is that if the rest of the funding has to come from local authorities as the numbers continue to increase, something else will have to give. My fear is that, owing to this duty, other vulnerable people who benefit from care from local authorities on a discretionary basis will end up losing their care, or part of it. If the demand is higher than the impact assessment has concluded, the impact will again be on local authorities here and now, and the potential consequences could be very damaging.
	Our second core concern is that the proposal is a partial solution. I think that everyone recognises that. The Government's case is that it is a bridge to reform, but as long as it remains the only reform to have happened, and until we have more comprehensive reform, it will have perverse consequences. As the right hon. Member for Charnwood (Mr. Dorrell) has made very clear, it will provide an incentive for local authorities to push people into care homes. That is not a good thing, because it will change behaviour and will benefit one group of people but not another. Another perverse incentive was mentioned on Second Reading by the hon. Member for South Thanet-it will provide a disincentive to people who are considering insuring to protect themselves in old age.
	Another danger, or consequence, of the fact that the proposal is a partial solution is the inherent unfairness in the Bill. Why should we choose to support and provide free care to one group of people-those with critical need who are cared for at home-but not another group who, through no fault of their own, end up having to have their critical needs met in care homes because they simply cannot be cared for at home? That is perverse. Why should one group benefit and not another? The Government have provided no answer to that.
	Our third core concern is whether what is proposed would be the most effective use of public funds. The Green Paper strongly makes the case that in any reform we have a duty to ensure that we use public funds to the best possible effect to achieve the best outcome for all those who have care needs, but the Bill does not do that. The impact assessment confirms specifically that the group of elderly people who would benefit most from the proposal would be the wealthiest.

Andy Burnham: indicated dissent.

Norman Lamb: The Secretary of State shakes his head, but the impact assessment makes that clear. At paragraph 5.21, it states:
	"The recipients of free personal care are believed to fall into the bottom, 2nd and 3rd quintiles because even the wealthiest older people (who represent the main beneficiary group) are in the middle of the income distribution of society at large."
	In other words, the wealthiest elderly people are not the wealthiest people in society, but they are the main beneficiaries of the Bill. I find it bizarre that a Labour Government should choose to use available public funds to benefit most the wealthiest older people, given that there are many others with acute care needs. The conclusion must be that that is not the best use of available public funds.
	I am also concerned that the Bill has been oversold by the Government. The Minister again quoted a figure of 400,000 for the total number of people to benefit from free care, and that of course includes those who would benefit from reablement. However, when one looks at the number of new recipients of free care at home, the real figure is 110,000. The Government do not use that figure at all in their pronouncements.
	The Government say that the Bill protects the care of those currently receiving free care, but it is hard to envisage circumstances in which those in critical need who are benefiting from care on a means-tested basis would lose that care. Therefore, it is somewhat disingenuous to argue that there is some great benefit for that group. The new recipients of free care will total just 110,000. As the hon. Member for South Thanet made clear, that is a relatively small group, compared with the total number of people with care needs who will have to be supported in any final reform of the system.
	Finally, I find that it strains the use of language to describe this Bill as a bridge to reform. As a sceptic, the hon. Member for South Thanet made the best possible case for supporting the Bill but, whatever happens to it, we must all be committed to a more fundamental reform of the system. I think that we are all agreed on that.
	I want to repeat the case that I made on Second Reading. In this pre-election period, there is a real and overwhelming need for all parties to put aside their differences and to join in a process charged specifically with building and achieving consensus on this matter. I know that that would be supported massively by those groups outside Parliament who represent people with real care needs. Such a consensus would have the benefit of facilitating reform in the next Parliament, and it would also put pressure on whoever wins the next election to ensure that reform takes place.
	The hon. Member for South Thanet is absolutely right to say that the urgency of completing the reform process is overwhelming. We must not allow this Bill to delay that.

Tom Clarke: I think that I have listened to every speech and contribution made today, and I have found them extremely stimulating. Far from objecting to the Committee stage being taken on the Floor of this House, I take the view that we ought to do this much more often. I do not think that it takes away from the scrutiny performed in Committee upstairs, but I believe that people might get involved in what we do here to a greater extent if we had more of the transparency to which this Bill has been subjected today.
	I welcome the Bill, and I also welcome the contributions made by the Minister of State, my hon. Friend the Member for Corby (Phil Hope). A few harsh things have been said about him, but I have many relatives in the steel industry down in his area and they will be supporting him. They do not say that he does not distinguish his post, because he so clearly does. I am sure that they are proud to have him as their Member of Parliament.
	Briefly, I should like to thank the House for the involvement of people with learning disabilities. For all those who will benefit because they need personal care at home, the Bill is progressive, meaningful and welcome.
	Although we heard threats about what might happen in another place, I hope that people such as Lord Morris and Lord Ashley and many others there will recognise the progressive nature of the Bill and will see that the Government and many organisations have welcomed the provisions. I believe that they will welcome the fact that at this stage in our Parliament we have given such prominence to something so profoundly important. I hope that that will be a beacon and a signal of the relevance that we give these matters in the next Parliament, when I expect to be speaking from the same spot.

Stephen Dorrell: I begin a brief speech by congratulating the Minister on the way that he dealt with the Bill. He put the best gloss possible on it, as I have not the slightest doubt that the Bill was generated in No. 10 Downing street and imposed on his Department against its advice. I have been there, so I congratulate him on presenting a defence of what is, in policy terms, an indefensible measure.
	I shall go through the three key arguments, which are in many ways similar to those set out by the hon. Member for North Norfolk (Norman Lamb), to which I do not believe the Minister responded adequately during the debate, despite his polished performance. The first is the argument about the convention on human rights. The policy justification that the Government have offered for the Bill does not stack up as a defence against the concern that they made explicit in the explanatory memorandum to the Bill. There remains a set of unanswered questions about the Bill.
	My second set of concerns relate to the policy implications of the introduction of the group of people who will benefit from free social care. The Minister rightly said in his presentation that we should not let the best be the enemy of the good, that we must allow for incremental change and so on. I entirely agree with him about that, but it does not absolve the Government from the need to think about the policy implications of what they do today when projected forward to tomorrow.
	Last July the Government said clearly that we could not afford a solution on personal care that landed the cost on the taxpayer. That is in the Green Paper in a rather convoluted form, and the Minister confirmed today that that remains the Government's view, yet as a consequence of the Bill, a group of people is created in the middle of the social care requirement for whom that outcome is what the Government are now seeking to legislate-tax-funded free social care-not, as the Minister said several times in loose wording, for the most vulnerable, but for the second most vulnerable group.
	The most vulnerable are those with critical care needs, who need residential care. Those are still subject to means-testing under the Government's intended solution. Below them in the hierarchy of need is the group that has been identified by the Prime Minister as the people who should benefit from free social care. Then there is the whole of the rest of the social care group. It is a golden rule of policy that if a group of people is created in the middle of a much larger group, all of whom benefit from broadly the same type of care with constantly changing requirements, the result is a change in behaviour.
	What the Government have done is create a group of people-a very small group, when seen in the context of all those who benefit from social care-to whom they have offered the promise of free social care, which is precisely the policy solution that the Government, quite rightly in my view, ruled out in their Green Paper. By doing that, if the Bill reaches the statute book and is actioned next October, they will have created a huge policy problem for the evolution of social care policy in a way that is consistent with the principles rightly set out in the Green Paper last summer.

Andy Burnham: I am listening carefully to the right hon. Gentleman and I have great respect for the work that he did as Secretary of State for Health. Does he acknowledge, however, that the group of people he is identifying, with whom the Bill deals, have already been paying for their care out of their own pockets as their condition has deteriorated over the years? For that reason, the Bill is consistent with the reforms in which individuals pay something towards their own care, but do not have to bear the whole cost, which can in some cases be catastrophically high, as we know. The right hon. Gentleman seems to have no appreciation that these are people who will already have paid out a large amount towards the cost of their own care.

Stephen Dorrell: Of course I have an appreciation of that, but I would like the Secretary of State to consider how he is going to explain to that same group of people who have paid out under the current regime that they will get free personal care when they are in their own home, but, as their care needs become more exaggerated and they have to go into residential care, they will have to start paying again. How is he going to explain that to them? That will be the consequence of the policy prescription that he is introducing.
	I have three concerns about the Bill, as I have said. The first is the human rights implication. The second is the implication for broader social care delivery of the introduction of free care for this group of people. The third echoes the question raised by my hon. Friend the Member for Eddisbury (Mr. O'Brien) and the hon. Member for North Norfolk: where is the money coming from? The Government say that this will involve £500 million, but I do not believe that. I certainly do not believe that it will be £500 million when the behavioural impact has been taken into account.
	At a time of huge competition for resources, the Department has been landed with bad policy by the Prime Minister, which will lead to resources being channelled to a particular group of people. Those people are very deserving-I do not deny that. I accept that they will benefit, and that they have contributed substantially to their care. They will suddenly receive that care free for as long as they do not need to be in residential care. Of course they will be significant beneficiaries, but seen in the context of the pressure on resources that the Government of this country-whoever they are-will have to address, over not just the next six to 12 months but the next five years, this seems to be bad policy which has been made on the hoof and will have all kinds of long-term negative consequences that have not been thought through. I entirely agree with the criticisms of the Bill that have been articulated by Lord Lipsey, and I rest my case on his presentation of the case.

Laura Moffatt: I do not care where the Bill was born or who dreamt it up; I am just extremely glad that I have stuck with it, right from the early days of the consultation paper when I considered these matters with my constituents. My constituents do not care either; they are just very pleased that we are able to be here today, giving the Bill a Third Reading. They believe that this is the right thing to do.
	It is easy to over-complicate the Bill. It is also easy to spend a whole day doing down its aims and objectives. We know, however, that it will benefit a significant number of people. Most of us-certainly those of us, on both sides of the House, who have taken a serious, forensic interest in the Bill from the word go-will completely understand that we would love to move straight to a national care system. Anyone who has worked in the care system, as I have, will know that that is our objective. I have to say, however, that the one true thing that the Bill does is send a clear signal to our constituents that this Government are very keen to ensure that people receive the care that they need, free at the point of use, with the reassurance that they will be able to live their lives out in their homes if that is what they want. And that is what they want.
	 Question put and agreed to.
	 Bill accordingly read the Third time and passed.

Business without Debate
	 — 
	Delegated Legislation

Motion made, and Question put forthwith (Standing Order No. 118(6)),

Health Care and Associated Professions

That the draft General and Specialist Medical Practice (Education, Training and Qualifications) Order 2010, which was laid before this House on 18 November, be approved. -( Mr. Blizzard .)
	 Question agreed to.
	 Motion made, and Question put forthwith (Standing Order No. 118(6)),

Taxes

That the draft Double Taxation Relief and International Tax Enforcement (Luxembourg) Order 2009, which was laid before this House on 23 November, be approved. -( Mr. Blizzard .)
	 Question agreed to.
	 Motion made, and Question put forthwith (Standing Order No. 118(6)),

Taxes

That the draft Double Taxation Relief and International Tax Enforcement (Qatar) Order 2009, which was laid before this House on 23 November, be approved. -( Mr. Blizzard .)
	 Question agreed to.
	 Motion made, and Question put forthwith (Standing Order No. 118(6)),

Taxes

That the draft Double Taxation Relief and International Tax Enforcement (Libya) Order 2009, which was laid before this House on 23 November, be approved. -( Mr. Blizzard .)
	 Question agreed to.
	 Motion made, and Question put forthwith (Standing Order No. 118(6)),

International Development

That the draft Asian Development Bank (Further Payments to Capital Stock) Order 2009, which was laid before this House on 24 November, be approved. -( Mr. Blizzard .)
	 Question agreed to.

DELEGATED LEGISLATION

Ordered,
	That the Major Accident Off-Site Emergency Plan (Management of Waste from Extractive Industries) (England and Wales) Regulations 2009 (S.I., 2009, No. 1927), dated 16 July 2009, be referred to a Delegated Legislation Committee. -( Mr. Blizzard .)

Business of the House

Ordered,
	That, at the sitting on Thursday 14 January, notwithstanding Standing Order No. 20 (Time for taking private business) the Private Business set down by the Chairman of Ways and Means may be entered upon at any hour, and may then be proceeded with, though opposed, for three hours, after which the Speaker shall interrupt the business. -( Mr. Blizzard .)

PETITION
	 — 
	New Ferry Butterfly Park

Ben Chapman: The many residents of Wirral, South, and people beyond, have contacted me to express their concern for the future of the much-loved butterfly park in New Ferry, which is threatened with closure. Our community is united in support of this invaluable local asset, which is also used by groups across the wider region.
	The petition states:
	The Petition of residents of Wirral South and others,
	Declares that the Petitioners object to the threatened closure of New Ferry Butterfly Park.
	The Petitioners therefore request that the House of Commons urges the Secretary of State for Environment, Food and Rural Affairs to encourage Wirral Council and others to do all they can to secure the retention of the Butterfly Park.
	And the Petitioners remain, etc.
	[P000699]

STUDENT FINANCE

Motion made, and Question proposed, That this House do now adjourn. -(Mr. Blizzard.)

Janet Dean: I am grateful for the opportunity to raise what I believe is an unfair and, indeed, immoral situation regarding how we treat students who become seriously ill during their studies.
	Students who develop a serious illness, such as cancer, are currently expected to use their student loans to support themselves during their period of illness and treatment. I believe that this is unfair. It is distressing enough for such young people and their families to have to fight serious life-threatening illness, such as cancer, without having the need to abandon their university courses. They need the hope and expectation of returning to their studies when they recover. They want to maintain their place at university, and yet if they suspend, rather than abandon their courses, they are deemed to have income from their student loans. Students are not entitled to claim benefits for 28 weeks, and even after that period, their student loan is taken into account when calculating their benefits. They are deemed to have their student loan even if they do not draw it down. Ultimately, if the treatment is successful and the student recovers to return to university to complete their course, they will have four years of student loan to repay for a three-year degree course. That cannot be right.
	This important issue was raised with me in November 2007 by my constituent, Mr. Ian Leech, on behalf of his 20-year-old daughter, Melissa, who had been diagnosed in August of that year with non-Hodgkin's lymphoma. Melissa was a student at Aston university and had been due to begin her third year of studies in September 2007. Mr. Leech contacted me because Melissa's application for income support had been refused because she was treated as if she was merely taking a gap year from university.
	The response from my hon. Friend the Member for Warwick and Leamington (Mr. Plaskitt), who was then Parliamentary Under-Secretary at the Department for Work and Pensions, explained as follows:
	"generally, full-time students are not entitled to benefit for the duration of their course, including the vacations. This is because primary financial support for students comes from the educational maintenance system, which is designed for their needs, unlike the social security system".
	His reply went on to say:
	"However if a student is sick for more than 28 weeks, they may be entitled to Income Support and/or Housing Benefit as a disabled student, as long as they satisfy the incapacity test, of course, any income, including a student grant and loan, will be taken into account when calculating benefit entitlement."
	He also explained:
	"If a person qualifies for DLA they are then classed as a disabled student which would give entitlement to Income Support as well as the Disability Premium".
	I acknowledge that my hon. Friend was trying to be helpful, but of course unless someone is classified as terminally ill, there is a wait of three months for them to become eligible for disability living allowance.
	I was most grateful for the meeting that I had with my hon. Friend, who recognised the problem and kindly wrote to Melissa in March 2008 saying that he was aware of other people with similar problems. He promised to have discussions about how the system could be improved and wrote to me in May 2008:
	"Officials are working on the detail of changing the deeming rules so that students who become seriously ill and have not drawn down their student loan are not penalised".
	He added:
	"Assuming there are no major legal obstacles, we hope to implement a change to the regulations later this year".
	Sadly, Melissa lost her great battle and died in May 2008 supported by her caring mother, father and sister. Ian Leech has carried on his fight on behalf of other students in a similar position, and I should like to pay tribute to him for all his work in raising awareness of the condition and for his continued campaign to see fairness for students such as Melissa. His efforts in highlighting the plight of those with non-Hodgkin's lymphoma have been recognised in each of the last two years by the Lymphoma Association.
	Mr. Leech recognises that the problem of student support is complicated and that there are grey areas. In July 2008, he put forward suggestions for income support to become available for the term following the diagnosis of serious illness. For example, if someone was diagnosed in November they would use the rest of their student loan for that term until December and then be eligible for income support. Mr. Leech recognised that there were complications in relation to payment for student accommodation, which is paid in advance in some cases, and in relation to loans for tuition fees paid in advance in the autumn. However, it would be possible for a pro rata proportion to be refunded by the university to the Student Loans Company if someone's studies were suspended.
	I recognise that it is important to distinguish students who have a few weeks away from their studies because of ill health from those who have to take a year off because of serious ill health and treatment. If students are sick for a short time they can catch up with their studies without any extra cost to themselves, whereas those taking a year to recover from illness need to repay at least an extra year of student loan. It should not be too difficult to establish a system that enables medical evidence to be used to distinguish those with short-term illness from those who need to suspend their studies for a year.
	Unfortunately, the hoped-for changes that my hon. Friend the Member for Warwick and Leamington referred to in his letter to me in May 2008 have yet to be achieved. Some changes were made for students who abandon their course or are dismissed from it, but not for those who have to suspend it. Indeed, the changes made for those abandoning their course reflect the suggestions made by Mr. Leech. The Social Security (Students and Miscellaneous Amendments) Regulations 2008 mean that since August that year, when a student abandons or is dismissed from their course, the Department for Work and Pensions takes into account only the quarter that the loan is meant to cover-or if the loan is paid in two or more instalments in the quarter, the period of the quarter that the instalment is meant to cover-not the whole year.
	In November 2008, I received a response from the new Minister at the Department for Work and Pensions, my hon. Friend the Member for Burnley (Kitty Ussher), reassuring me:
	"We believe that there is a strong case for changing the deemed income rule for students who have not drawn down their student funding, fall seriously ill and need to suspend their studies."
	But she went on to say:
	"However, in the current economic climate, every new initiative is being scrutinised and so far it has not been possible to secure the necessary funding to implement the change. Officials will continue to press on with this, but I cannot promise an early resolution."
	You will understand, Mr. Speaker, that both Ian Leech and myself were disappointed by that. After further correspondence with Ministers I was grateful that my right hon. Friend the Minister for Higher Education and Intellectual Property agreed to meet me, together with my hon. Friend the Member for Warwick and Leamington.
	 Motion lapsed (Standing Order No. 9(3)).
	 Motion made and Question proposed, That this House do now adjourn.-( Mr. Blizzard.)

Janet Dean: After the meeting in March 2009, the Minister wrote to the Department for Work and Pensions in support of changes to the benefit rules for those who are absent from their course because of long-term illness, but who remain enrolled at their university so that they would not be classified as being in full-time education for benefit purposes.
	In June 2009, better news came from the Treasury in a letter from the Chief Secretary to the Treasury, which said that
	"in current economic circumstances, all new policy changes need to be thoroughly scrutinised, and affordability must be assured, before any commitments can be made. I will, however, look carefully at the case for this change as part of the Pre-Budget Report."
	This was confirmed to me in a letter from my hon. Friend the Work and Pensions Minister in August 2009 in which she says:
	"Treasury officials have said that they would be willing to consider implementing the change in the next Pre-Budget Report".
	Sadly, changes were not announced in the pre-Budget report, even though I know that my hon. Friend the Minister pressed the Treasury for the funding to implement this much-needed change following our meeting early in November.
	Students who become seriously ill are still suffering because the current system lets them down. As Mr. Leech said to me, a student should not be expected to have to endure a long-term illness and use money to live on that they then have to repay. As he says, that does not apply to the employed, the unemployed or the retired. Students are being singled out and persecuted. He also believes that the human rights of students with long-term illnesses are being violated because they are treated differently from other members of society.
	Because of Ian Leech's campaign, students contacted him from around the country through the Lymphoma Association, and one such student, Blair Ward, wants her story told. Blair says:
	"Not only am I a student at the University of Central Lancashire, Preston, but I also work part-time as a cashier at Asda at weekends. When I was diagnosed, I didn't work enough hours at Asda to receive sick pay, so I contacted Macmillan who suggested I claim for Employment Allowance"-
	I believe that she means employment support allowance. She continues:
	"I filled out all the relevant forms and obtained the supporting evidence, only to be rejected as a result of my still having a position on my degree course and being classed as a full-time student, even though I wasn't able to attend university, as I was taking time out to receive treatment. Therefore I wasn't receiving any income from either Asda or the Student Loan Company.
	I appealed against this decision stating that I wasn't receiving any student finance and that I had had no income for over 9 months, but again I was unsuccessful. I had to use a huge amount of my savings to buy new clothes for the winter, spring and summer months, as a result of my gaining several stones in weight, which was due to the course of steroids I was put on as part of my treatment. I also had to pay for petrol and the general running costs of my car to get to the hospital appointments."
	Thankfully Blair has now returned to university, but her experience describes how it can be more costly to be ill, with expenses such as travel and personal items, such as clothes.
	Serious ill health is difficult to cope with at any age, but for young people and their families it is particularly tragic. It is bad enough coping with the stress of diagnosis and treatment without the added pressure of the unfairness of the benefits system for students. All Departments now accept that unfairness.
	No one seems to know how many students have to suspend their studies because of serious illness; however, numbers are likely to be small. It is likely that the numbers who have to suspend their courses is less than those who abandon or are dismissed from their courses and have been helped by the Social Security (Students and Miscellaneous Amendments) Regulations 2008. The proposal from the DWP is that employment support allowance for students who suspend their studies because of serious ill health be treated in a similar way. I welcome that proposal and urge my hon. Friend the Minister to ensure that a way is found to achieve justice for students with serious illness. It would be immoral, unfair and unjust not to address the problem.

James Plaskitt: I congratulate my hon. Friend the Member for Burton (Mrs. Dean) on raising this issue and I thank her for allowing me an opportunity to make a brief speech. I appreciate the fact that she has persevered and persisted with the issue-she has spoken eloquently about it on a number of occasions, including tonight. I also acknowledge the contribution of Ian Leech, who has campaigned admirably and with great foresight.
	As my hon. Friend said, she brought Melissa's case to me when I was responsible for this area of the benefits system in the Department for Work and Pensions. I initially took the official line, as Ministers invariably do, which she quoted. However, after she came to meet me to discuss Melissa's case in some detail, I came to the conclusion that the regulations were quite simply wrong and indefensible. That is how the process of trying to remedy and correct the situation began. Unfortunately, I left the DWP before the task was completed.
	In my view, this has been a story of a completely justifiable reform repeatedly getting up to the last fence before for some reason falling. I hope that we do not have to persuade the Government that the reform needs to take place-the research has been done and the case has been made. It is simply a matter of having the will to get over that last fence to remedy this clear injustice, which I hope will happen before this Parliament ends.
	When I had a go at trying to resolve the problem, it suffered a bit of ping-pong between the DWP and the education Department. There was an argument over who was going to pick up the tab, and for a while there was an argument over the numbers, but those are not critical issues and they can be resolved with continuing commitment from the two Departments.
	I have three brief points to make before the Minister responds. First, I agree that the numbers are small. Therefore, the cost of making the adjustment that is required is also small. Will she commit to trying to determine the numbers? Universities UK probably has the information, but neither my hon. Friend the Member for Burton nor I have managed to flush it out. If the Minister undertook to make that inquiry, we could establish the numbers. In that way, we would be certain about the potential cost of the small change that is required.
	Secondly, I do not believe that a solution is difficult to find. I hope that the pass the parcel between the two Departments comes to an end. All we need is to agree in regulations a specification of serious illness, which I do not think is too difficult to establish. We would then have to make the necessary regulatory alteration to allow students who have had to come off their courses because they have been diagnosed with such illnesses access to income support benefits. I am confident that that can be worked out.
	Thirdly, I welcome the 2008 regulatory change, as does my hon. Friend the Member for Burton, but I think it odd to make that change, which was a concession within the benefits system for students who decided for some reason to leave their course, or who were ejected from their course, so that they could access the benefits system, yet not make the change for students who leave their course not through their own will, but because they have been diagnosed with a serious illness. They have been given no choice medically but to come off their course, yet we say that there is no benefit support for them. At the same time, we say that there is benefit support for someone who comes off their course for some arbitrary reason. That has made the situation still less defensible than it was before. The 2008 changes in the regulations were a wholly understandable reform, but they have had the slightly perverse effect of making the injustice we are talking about even more stark.
	Let me conclude by saying that I wish that I had managed to get the problem sorted out. I have great admiration for the fact that my hon. Friend has persisted with her campaign. I have tried to help as she has gone along, but this is essentially an issue on which she has taken the lead, and in an admirable way. The problem is not difficult, and I think that the solution is obvious. We have got close to implementing it on two or three occasions. I hope that before this Parliament ends we will hear from the Minister that there is a commitment from the Department to getting what is a justifiable and urgent reform over the last hurdle and actually implementing it.

Helen Goodman: I, too, would like to congratulate my hon. Friend the Member for Burton (Mrs. Dean) on securing the debate. Let me say how much I appreciate her concern and the effort that she has expended in taking up the issue, which stems from the particularly distressing case of Melissa Leech. As my hon. Friend said, Melissa's father Ian has also campaigned vigorously for students who suffer from severe illness that causes them to halt their studies. My hon. Friend outlined the details of Melissa's case and subsequent death, and made an eloquent case, which deserves the fullest understanding. She has also been persistent in pressing the issue of support for students who find themselves in such circumstances. I was also pleased to hear the perspective of my predecessor, my hon. Friend the Member for Warwick and Leamington (Mr. Plaskitt). I had not realised how long the discussion had been going on, so I was pleased to have his input into this debate.
	Let me begin by explaining what financial support is currently available for students, including those who fall ill and are unable to continue their studies because of their illness. As hon. Members will know, the social security regulations were changed in 1990. The automatic entitlement of full-time students of 19 or over to jobseeker's allowance, income support and housing benefit was removed at that point. The Government believe that those who want to take the route of full-time study should become the responsibility of the education system and should therefore not normally be eligible for income-related benefits. That is to avoid duplication of financial support.
	That policy happened to coincide with the introduction, by the then Department of Education and Science, of top-up loans for students and student access funds, which allow colleges to give discretionary payments in cases of hardship. More recently, the Government have introduced the maintenance grant and the special support grant, which are available to those who need help with accommodation and other living costs. They are grants, not loans, that have to be repaid. The special support grant is available to those who receive income support or housing benefit. The Government have concluded that the education system is best placed to provide the primary financial support needed for the entire period of a student's course of study. Such support is designed specifically to meet the needs of students, unlike the welfare system. However, in recognition of the fact that some students have expenses unconnected with their study, those in vulnerable groups retain an entitlement to benefits. They include student couples with children, lone parents, disabled students and people aged 60 or over.
	When a student falls ill, they can be absent from their course for up to 60 days and remain eligible for student finance. If they need extra help, their university or college can make payments from its access to learning fund during that period. If a student is ill for more than 60 days, their local authority can choose to continue paying them student finance, as long as they remain enrolled on their course. However, they may be too ill to continue their course and may need to abandon it. When a student has to abandon their course and needs to apply for welfare benefits, we treat them just as we are required to treat any other person. We must take into account their financial resources and any resource that may be available to them. In the case of a student, that is usually a student loan, which is the main means of financial support for the majority of students. We take into account the period for which the loan has been made, which, as my hon. Friend the Member for Burton pointed out, is not the whole year, but the quarter during which the request for welfare help has been made. We introduced that change in August 2008 in order not to penalise those who had had to give up their courses. At the moment, this applies only if the student ceases to be a student; if they do not cease to be one, they are not under current rules able to claim benefits. This is what my hon. Friend wants to see changed.
	My hon. Friend raised the issue of deeming income. We have a deeming rule for all customers who wish to access benefits. Let me explain why we need to deem available income when it might not have been taken up. Benefits are payable only when no other income is reasonably available, so there are strict rules covering the availability and use of income. For example, someone who has money but disposes of it may be disallowed from benefit because they are considered to have disposed of it in order to claim benefit. Similarly, someone able to obtain financial support from elsewhere but does not do so and then claims benefit may be disallowed because they have other resources available. Anyone who wishes to receive benefits must first show that they have taken up any available financial support. In the case of students, this will be the student loan.
	I do appreciate that a student faced with the appalling knowledge of a possibly fatal illness may want to keep their status as a student in order to hold out some hope for the future. The difficulty at the moment is that there are clear rules covering students, the clearest being that full-time students are not entitled to benefit, including during the vacation period.
	Let me turn to what we could do to improve the situation for students in these difficult circumstances. As a start, I feel we can go a long way to alleviating the problems for students who find themselves in such difficult circumstances by making sure, as far as we can, that they get the right advice at the right time. If students and those who advise them are better informed about the financial support available to them in a range of circumstances, students will be better placed to deal with the financial issues, should they fall seriously ill.
	My officials have been working with their opposite numbers in the Department for Business, Innovation and Skills to improve guidance to universities so that students receive clear and consistent advice. They have also taken advice from the National Association of Student Money Advisers. I would stress the importance of students contacting their college advisers and their student union as soon as possible, and Jobcentre Plus if the student feels that they may be able to claim welfare support. There is a good deal of useful information for students on the Directgov website.
	I appreciate that arrangements for supporting full-time higher education students can be far from clear and straightforward. For example, we make exceptions in the benefits system for certain groups that are considered to be vulnerable, whether they be students or not. Each of those exceptions brings its own particular circumstances that have to be taken into account. This inevitably adds to the complexity of the financial support system.
	Particularly in the light of what has been said this evening, I think it is an appropriate time to consider whether there is any way that we can simplify and improve the transparency of the arrangements. I will explore ways forward with BIS, education providers and student representative bodies.
	I appreciate my hon. Friend's case for dropping the deeming principle in some cases, and I understand that additional costs to the Exchequer are not likely to be large, as such cases are few and far between.

Janet Dean: I am grateful to the Minister for saying that she is going to look at how we can move this forward, but does she accept that it is likely that there will be far fewer students who have to suspend because of illness than there will be those who give up or are dismissed from their courses, who can claim benefits more or less straight away? Does she see the unfairness? Does she accept that students who want that hope of going back to a course-indeed, in most cases, they probably do-should not have to give it up, but should be able to suspend it for a year?

Helen Goodman: I do understand the unfairness to which my hon. Friend refers. I was about to say that the number of cases like this are so small that we probably do not need to explore in great detail how many there actually are. I do not think that the cost to the Exchequer would be a significant barrier to securing the change.
	I want to make positive progress without complicating the system. If a change to the current deeming provision is to work properly, we must have a clear understanding of which types of illness-mental or physical-genuinely prevent someone from continuing their studies for a period of time, and we must be able to define those circumstances clearly so that both our customers and our benefits advisers understand the regulations.
	I will ask my officials to speak to our medical colleagues and lawyers, and to seek their help in setting out clear criteria for an easement of the rules. We will also ensure that the representative student bodies and university authorities have an input, and will use the time available to us to spread awareness of the issues as widely as possible. I want to be sure that if we make a change we get it absolutely right, and avoid in future the kind of distress caused in Melissa Leech's case.
	 Question put and agreed to.
	 House adjourned.